Peripheral opioid receptor antagonists and uses thereof

ABSTRACT

The present invention provides a compound of formula I: 
                         
wherein X − , R 1 , and R 2  are as defined herein, and compositions thereof.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.13/546,500, filed Jul. 11, 2012, which is a continuation of U.S.application Ser. No. 12/570,891, filed Sep. 30, 2009, which claimspriority to U.S. Provisional Patent Application No. 61/101,201, filedSep. 30, 2008, U.S. Provisional Patent Application No. 61/226,581, filedJul. 17, 2009 and U.S. Provisional Patent Application No. 61/237,428,filed Aug. 27, 2009, the entirety of each of which is herebyincorporated herein by reference.

BACKGROUND OF THE INVENTION

Opioids are widely used in patients with advanced cancers and otherterminal diseases to reduce suffering. Opioids are narcotic medicationsthat activate opioid receptors located in the central nervous system torelieve pain. Opioids, however, also react with receptors outside of thecentral nervous system, resulting in side effects includingconstipation, nausea, vomiting, urinary retention, and severe itching.Most notable are the effects in the gastrointestinal tract (GI) whereopioids inhibit gastric emptying and propulsive motor activity of theintestine, thereby decreasing the rate of intestinal transit andproducing constipation. The effectiveness of opioids for pain is oftenlimited due to resultant side effects, which can be debilitating andoften cause patients to cease use of opioid analgesics.

In addition to analgesic opioid induced side effects, studies havesuggested that endogenous opioid compounds and receptors may also affectactivity of the gastrointestinal (GI) tract and may be involved innormal regulation of intestinal motility and mucosal transport of fluidsin both animals and man. (Koch, T. R, et al, Digestive Diseases andSciences 1991, 36, 712-728; Schuller, A. G. P., et al., Society ofNeuroscience Abstracts 1998, 24, 524, Reisine, T., and Pasternak, G.,Goodman & Gilman's The Pharmacological Basis of Therapeutics NinthEdition 1996, 521-555 and Bagnol, D., et at., Regui. Pept. 1993, 47,259-273). Thus, an abnormal physiological level of endogenous compoundsand/or receptor activity may lead to bowel dysfunction.

For example, patients who have undergone surgical procedures, especiallysurgery of the abdomen, often suffer from a particular boweldysfunction, called post-operative (or post-surgical) ileus, that may becaused by fluctuations in natural opioid levels. Similarly, women whohave recently given birth commonly suffer from post-partum ileus, whichis thought to be caused by similar natural opioid fluctuations as aresult of birthing stress. Gastrointestinal dysfunction associated withpost-operative or post partum ileus can typically last for 3 to 5 days,with some severe cases lasting more than a week. Administration ofopioid analgesics to a patient after surgery, which is now an almostuniversal practice, may exacerbate bowel dysfunction, thereby delayingrecovery of normal bowel function, prolonging hospital stays, andincreasing medical care costs.

Methylnaltrexone (“MNTX”) is a derivative of the opioid antagonist,naltrexone, whereby the amine is quarternized. MNTX is commonly providedas a salt, for example, a bromide salt. The bromide salt of MNTX is alsoknown in the literature as: methylnaltrexone bromide; N-methylnaltrexonebromide; naltrexone methobromide; naltrexone methyl bromide; and MRZ2663BR. MNTX was first reported by Goldberg et al. as described in U.S.Pat. No. 4,176,186. It is believed that addition of the methyl group tothe ring nitrogen of naltrexone forms a charged compound with greaterpolarity and less liposolubility than naltrexone, preventing MNTX fromcrossing the blood-brain barrier in humans. As a consequence, MNTXexerts its effects in the periphery rather than in the central nervoussystem with the advantage that it does not counteract the analgesiceffects of opioids on the central nervous system.

Generally, pharmaceutical compositions require a high level of purity tomeet regulated standards for drug quality and purity. For example,during synthesis and/or storage of MNTX, impurities may form which mayhinder the therapeutic effects of MNTX and/or may be toxic if present inhigh enough quantity. As such, it is desirable to have the ability todetermine the purity of MNTX. To that end, it is important to identify;isolate, and chemically characterize impurities and degradants which canbe used in chromatographic procedures as standards to confirm the purityof MNTX.

SUMMARY

In certain embodiments, the present invention relates to theidentification, purification, and synthesis of an impurity of MNTX. Ithas been discovered that this compound can arise as an impurity eitherin the process for manufacturing MNTX or as a degradant when certainsolutions of MNTX are stored under certain conditions. Accordingly, incertain embodiments, the present invention provides a compound offormula II:

wherein X⁻, R¹, and R² are as defined and described herein. In someembodiments, provided compounds are peripheral μ opioid receptorantagonists. Other uses of provided compounds are set forth infra.

The present invention also provides a prefilled syringe comprising aliquid composition comprising methylnaltrexone. In some embodiments, aprefilled syringe is substantially free of tungsten, or a derivativethereof. Such prefilled syringes, and uses thereof, are described indetail herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts the LC/MS result of a stability study of amethylnaltrexone pre-filled syringe at 40° C. and 75% relative humidityafter 6 months.

FIG. 2 depicts the total ion chromatogram (TIC), UV chromatogram (λ=280nm), mass and UV spectra obtained for the RRT 0.60 peak.

FIG. 3 depicts the effect of pH on reaction of compound III-1 with H₂O₂to form compound II-1.

FIG. 4 shows the UV chromatogram of a stability sample and thechromatogram of a stability sample spiked with compound II-1 preparedaccording to Example 2.

FIG. 5 depicts the fragmentation assignments of compound II-1 with thechemical structure based on NMR data.

FIG. 6 depicts the COSY spectrum of compound II-1.

FIG. 7 depicts the HSQC spectrum of compound II-1.

FIG. 8 depicts the ¹H NMR spectrum of compound II-1.

FIG. 9 depicts the HMBC spectrum of compound II-1.

FIG. 10 depicts the ROESY spectrum of compound II-1.

FIG. 11 depicts the ¹³C NMR spectrum of compound II-1.

FIG. 12 depicts the X-ray diffraction pattern of crystalline compoundII-1.

FIG. 13 depicts the mass spectrogram and mass measurement of the M+H ionof compound II-1 crystals.

FIG. 14 depicts the ¹H NMR spectrum of compound II-1.

FIG. 15 depicts the X-ray diffraction pattern of crystalline compoundII-1.

DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS OF THE INVENTION 1.Compounds and Definitions

In certain embodiments, the present invention provides a compound offormula I:

wherein:R¹ and R² are each independently C₁₋₆ aliphatic; andX⁻ is a suitable anion.

The term “aliphatic” or “aliphatic group”, as used herein, means astraight-chain (i.e., unbranched) or branched hydrocarbon chain that iscompletely saturated or that contains one or more units of unsaturation,or a monocyclic hydrocarbon that is completely saturated or thatcontains one or more units of unsaturation, but which is not aromatic(also referred to herein as “carbocycle” “cycloaliphatic” or“cycloalkyl”), that has a single point of attachment to the rest of themolecule. In certain embodiments, an aliphatic group contains 1-4aliphatic carbon atoms, and in yet other embodiments, an aliphatic groupcontains 1-3 aliphatic carbon atoms. In some embodiments,“cycloaliphatic” (or “carbocycle”) refers to a monocyclic C₃-C₆hydrocarbon that is completely saturated or that contains one or moreunits of unsaturation, but which is not aromatic, that has a singlepoint of attachment to the rest of the molecule. Such cycloaliphaticgroups include cycloalkyl, cycloalkenyl, and cycloalkynyl groups.Suitable aliphatic groups include, but are not limited to, linear orbranched alkyl, alkenyl, alkynyl groups and hybrids thereof such as(cycloalkyl)alkyl, (cycloalkenyl)alkyl or (cycloalkyl)alkenyl. Exemplaryaliphatic groups include allyl, vinyl, cyclopropylmethyl, methyl, ethyl,isopropyl, and the like.

The term “unsaturated,” as used herein, means that a moiety has one ormore units of unsaturation.

The term “lower alkyl,” as used herein, refers to a hydrocarbon chainhaving up to 4 carbon atoms, preferably 1 to 3 carbon atoms, and morepreferably 1 to 2 carbon atoms. The term “alkyl” includes, but is notlimited to, straight and branched chains such as methyl, ethyl,n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, or t-butyl.

As used herein, an “effective amount” of a compound or pharmaceuticallyacceptable composition can achieve a desired therapeutic and/orprophylactic effect. In some embodiments, an “effective amount” is atleast a minimal amount of a compound, or composition containing acompound, which is sufficient for treating one or more symptoms of adisorder or condition associated with modulation of peripheral μ opioidreceptors, such as side effects associated with opioid analgesic therapy(e.g., gastrointestinal dysfunction (e.g., dysmotility constipation,etc.), nausea, emesis, (e.g., nausea), etc.). In certain embodiments, an“effective amount” of a compound, or composition containing a compound,is sufficient for treating one or more symptoms associated with, adisease associated with aberrant endogenous peripheral opoid or μ opioidreceptor activity (e.g., idiopathic constipation, ileus, etc.).

The term “prefilled syringe” refers to a syringe that contains a drugproduct such as a solution of methylnaltrexone and is pre-packaged foruse by a subject such as for self-administration or administration byanother such as a medical professional. In certain embodiments, aprefilled syringe is provided in a sterile package. In some embodiments,such a package contains a plurality of prefilled syringes.

The term “subject”, as used herein, means a mammal and includes humanand animal subjects, such as domestic animals (e.g., horses, dogs, cats,etc.).

The terms “suffer” or “suffering” as used herein refers to one or moreconditions that a patient has been diagnosed with, or is suspected tohave.

The terms “treat” or “treating,” as used herein, refers to partially orcompletely alleviating, inhibiting, delaying onset of, preventing,ameliorating and/or relieving a disorder or condition, or one or moresymptoms of the disorder or condition.

“Therapeutically active agent” or “active agent” refers to a substance,including a biologically active substance, that is useful for therapy(e.g., human therapy, veterinary therapy), including prophylactic andtherapeutic treatment. Therapeutically active agents include organicmolecules that are drug compounds, peptides, proteins, carbohydrates,monosaccharides, oligosaccharides, polysaccharides, nucleoprotein,mucoprotein, lipoprotein, synthetic polypeptide or protein, smallmolecules linked to a protein, glycoprotein, steroid, nucleic acid, DNA,RNA, nucleotide, nucleoside, oligonucleotides, antisenseoligonucleotides, lipid, hormone, and vitamin. Therapeutically activeagents include any substance used as a medicine for treatment,prevention, delay, reduction or amelioration of a diseases, condition,or disorder. Among therapeutically active agents useful in theformulations of the present invention are opioid receptor antagonistcompounds, opioid analgesic compounds, and the like. Further detaileddescription of compounds useful as therapeutically active agents isprovided below. A therapeutically active agent includes a compound thatincreases the effect or effectiveness of a second compound, for example,by enhancing potency or reducing adverse effects of a second compound.

“Tungsten, or a derivative thereof” refers to tungsten, a salt thereof,an oxidized form thereof or a tungsten-containing alloy. The term“tungsten” is used interchangeably with the phrase “tungsten, or aderivative thereof.”

The expression “unit dosage form” as used herein refers to a physicallydiscrete unit of inventive formulation appropriate for administration toa subject to be treated. It will be understood, however, that the totaldaily usage of the compositions of the present invention will be decidedby the attending physician within the scope of sound medical judgment.The specific effective dose level for any particular subject or organismwill depend upon a variety of factors including the disorder beingtreated and the severity of the disorder; activity of specific activeagent employed; specific composition employed; age, body weight, generalhealth, sex and diet of the subject; time of administration, and rate ofexcretion of the specific active agent employed; duration of thetreatment; drugs and/or additional therapies used in combination orcoincidental with specific compound(s) employed, and like factors wellknown in the medical arts.

2. Description of Exemplary Compounds

As described generally above, the present invention provides a compoundof formula I:

wherein:R¹ and R² are each independently C₁₋₆ aliphatic; andX⁻ is a suitable anion.

One of ordinary skill in the art will recognize that the nitrogen atomdepicted in formula I is a chiral center and, therefore, can exist ineither the (R) or (S) configuration. According to one aspect, thepresent invention provides a compound of formula I wherein the compoundis in the (R) configuration with respect to the nitrogen. In certainembodiments of the present invention, at least about 99.6%, 99.7%,99.8%, 99.85%, 99.9%, or 99.95% of a compound of formula I is in the (R)configuration with respect to nitrogen.

As defined generally above, the X⁻ group of formula I is a suitableanion. In certain embodiments, X⁻ is the anion of a suitable Brønstedacid. Exemplary Brønsted acids include hydrogen halides, carboxylicacids, sulfonic acids, sulfuric acid, and phosphoric acid. In certainembodiments, X⁻ is chloride, bromide, iodide, fluoride, sulfate,bisulfate, tartrate, nitrate, citrate, bitartrate, carbonate, phosphate,malate, maleate, fumarate sulfonate, methylsulfonate, formate,carboxylate, sulfate, methylsulfate or succinate salt. In certainembodiments, X⁻ is trifluoroacetate. According to one aspect, X⁻ isbromide.

It is readily apparent that a compound of formula contains both aquaternized nitrogen group and a phenolic hydroxyl group. One ofordinary skill in the art will recognize that the phenolic hydroxylgroup of a compound of formula I can form a salt with the quaternizednitrogen of a, compound of formula I. Such salts can form between twomolecules of a compound of formula I-a via an intermolecular interactionor can form between those groups of the same compound via anintramolecular interaction. The present invention contemplates both suchsalt forms. Thus, in certain embodiments, the present invention providesa compound of formula I-a:

wherein R¹ and R² are each independently C₁₋₆ aliphatic.

In some embodiments, the present invention provides a compound offormula I-b:

wherein R¹ and R² are each independently C₁₋₆ aliphatic; andX⁻ is a suitable anion.

In certain embodiments, the present invention provides a compound offormula I wherein R¹ is C₁₋₄ aliphatic and R² is lower alkyl. In otherembodiments, the R¹ group is a (cycloalkyl)alkyl group or alkenyl group.According to certain embodiments, R¹ is cyclopropyl methyl or allyl. Inother embodiments, R¹ is cyclopropyl methyl or allyl and R² is methyl.In some embodiments, R¹ is methyl and R² is cyclopropyl methyl or allyl.

According to one embodiment, the present invention provides a compoundof formula II or II′:

wherein each X⁻ is a suitable anion as described herein.

In certain embodiments, the present invention provides compound II-a:

Exemplary compounds of formula II include compound II-1, II-2, and II-3:

According to another aspect, the present invention provides acomposition comprising:

(a) a compound of formula III or III′:

wherein A⁻ is a suitable anion,(b) at least one compound of formula I:

wherein:R¹ and R² are each independently C₁₋₆ aliphatic; andX⁻ is a suitable anion; and(c) optionally, a compound of formula IV:

wherein:R¹ and R² are each independently C₁₋₆ aliphatic; andX⁻ is a suitable anion.

In some embodiments, provided compositions are formulated for oraladministration. In certain embodiments, a provided compositioncomprising a compound of formula III, a compound of formula I, and,optionally, a compound of formula IV is a solid composition wherein:

-   -   (a) at least about 99.6%, 99.7%, 99.8%, 99.85%, 99.9%, or 99.95%        of the compound of formula III is in the (R) configuration with        respect to nitrogen; and    -   (b) the compound of formula I is present in an amount of 60, 10,        5, 3.3, 2.5, 1 ppm or less.

In other embodiments, the present invention provides a compositioncomprising a compound of formula III, a compound of formula I, and acompound of formula IV, wherein the compounds of formula I and IV arepresent in amount of less than about 60, about 10, about 5, about 3.3,about 2.5, or about 1 ppm total. In some embodiments, provided solidformulations comprise from about 7% to about 75% or about 25% to about65% or about 25% to about 55%, or about 40% to about 50% or about 20% toabout 40% of a compound of formula II, based upon total weight of thesolid formulation. In certain embodiments, provided solid formulationscomprise from about 7%, about 8%, about 10%, about 20%, about 30%, about40%, about 50%, about 60%, about 70%, or about 75% a compound of formulaIII, based upon total weight of the solid formulation.

In some embodiments, an oral solid formulation contains 50 mg, 75 mg,100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, 250 mg, 275 mg, 300 mg,325 mg, 350 mg, 375 mg, 400 mg, 425 g, 450 mg, 475 mg, or 500 mg, 525mg, 550 mg, 575 mg, 600 mg, 625 mg, 650 mg, 675 mg, 700 mg, 725 mg, 750mg, 775 mg, 800 mg, 825 mg, 850 mg, 875 mg, 900 mg, 925 mg, 950 mg, 975mg, 1000 mg, 1025 mg, 1050 mg, 1075 mg, 1100 mg, 1125 mg, 1150 mg, 1175mg, 1200 mg, 1225 mg, 1250 mg, 1275 mg, 1300 mg, 1325 mg, 1350 mg, 1375mg, 1400 mg, 1425 mg, 1450 mg, 1475 mg, 1500 mg of a compound of formulaIII. In some embodiments, an oral solid formulation contains between 50mg and 900 mg, inclusive, or between 150 mg and 450 mg, inclusive, of acompound of formula III. In some embodiments, an oral solid formulationcontains 75 mg, 150 mg, 225 mg, 300 mg, 450 mg, 600 mg, or 900 mg of acompound of formula II. In certain embodiments, any such oral solidformulation wherein the compounds of formula I and IV are present inamount of less than about 60, about 10, about 5, about 3.3, about 2.5,or about 1 ppm total.

In some embodiments, the present invention provides a solid formulationfor oral administration wherein said formulation comprises a compound offormula III, a compound of formula II, and optionally a compound offormula IV wherein the formulation provides no more than 1.5 microgramsof a compound of formula II per dose. In certain embodiments, thepresent invention provides a solid formulation for oral administrationwherein said formulation comprises a compound of formula III, a compoundof formula II, and a compound of formula IV wherein the formulationprovides no more than 1.5 micrograms total of a compound of formula IIand a compound of formula IV per dose.

In certain embodiments, such compositions are formulated in a liquidformulation. Such liquid formulations are described in detail inWO2008/019115, published Feb. 14, 2008, the entirety of which is herebyincorporated herein by reference. In some embodiments, the presentinvention provides a composition comprising a compound of formula IIIand a compound of formula I, where the amount of compound of formula Iin the composition is less than about 25, about 100, about 125, about150, about 185, about 187, or about 190 ppm. In some embodiments, thepresent invention provides a composition comprising a compound offormula III, a compound of formula I, and a compound of formula IV,wherein the compounds of formula I and IV are present in amount of lessthan about 25, about 100, about 125, about 150, about 185, about 187, orabout 190 ppm total.

As defined generally above, the A⁻ group of formula II is a suitableanion. In certain embodiments, A⁻ is the anion of a suitable Brønstedacid. Exemplary Brønsted acids include hydrogen halides, carboxylicacids, sulfonic acids, sulfuric acid, and phosphoric acid. In certainembodiments, A⁻ is chloride, bromide, iodide, fluoride, sulfate,bisulfate, tartrate, nitrate, citrate, bitartrate, carbonate, phosphate,malate, maleate, fumarate sulfonate, methylsulfonate, formate,carboxylate, sulfate, methylsulfate or succinate salt. In certainembodiments, X⁻ is trifluoroacetate. According to one aspect, X⁻ isbromide.

It is readily apparent that a compound of formula III contains both aquaternized nitrogen group and a phenolic hydroxyl group. One ofordinary skill in the art will recognize that the phenolic hydroxylgroup of a compound of formula III can form a salt with the quaternizednitrogen of a compound of formula III. Such salts can form between twomolecules of a compound of formula III via an intermolecular interactionor can form between those groups of the same compound via anintramolecular interaction. The present invention contemplates both suchsalt forms.

International patent application publication number WO2006/127899describes Compound III-1, (R)—N-methylnaltrexone bromide, which has thefollowing structure:

where the compound is in the (R) configuration with respect to thenitrogen. In certain embodiments of the present invention, at leastabout 99.6%, 99.7%, 99.8%, 99.85%, 99.9%, or 99.95% of Compound III-1 isin the (R) configuration with respect to nitrogen. Methods fordetermining the amount of (R)—N-methylnaltrexone bromide, present in asample as compared to the amount of (S)—N-methylnaltrexone bromidepresent in that same sample, are described in detail in WO2006/127899,the entirety of which is hereby incorporated herein by reference. Inother embodiments, Compound III-1 contains 0.15% or less(S)—N-methylnaltrexone bromide.

In certain embodiments, the present invention provides a compound of thepresent invention in isolated form. As used herein, the term “isolated”means that a compound is provided in a form that is separated from othercomponents that might be present in that compound's usual environment(e.g., a reaction mixture, a chromatography eluent, a pharmaceuticalcomposition, etc.). In certain embodiments, an isolated compound is insolid form. In some embodiments, an isolated compound is at least about50% pure as determined by a suitable HPLC method. In certainembodiments, an isolated compound is at least about 60%, 70% 80%, 90%,95%, 98%, or 99% as determined by a suitable HPLC method.

In certain embodiments, the present invention provides a compositioncomprising:

(a) a compound of formula III and/or III′:

wherein A⁻ is a suitable anion,(b) at least one compound of formula II and/or II′:

wherein X⁻ is a suitable anion as described herein; and(c) optionally, a compound of formula IV-a and/or IV-a′:

wherein X⁻ is a suitable anion as described herein.

In certain embodiments, the present invention provides a solidcomposition comprising a compound of formula III, a compound of formulaII, and, optionally, a compound of formula IV-a wherein:

-   -   (a) at least about 99.6%, 99.7%, 99.8%, 99.85%, 99.9%, or 99.95%        of the compound of formula III is in the (R) configuration with        respect to nitrogen; and    -   (b) the compound of formula II is present in an amount of 60,        10, 5, 3.3, 2.5, 1 ppm or less.

In other embodiments, the present invention provides a compositioncomprising a compound of formula III, a compound of formula II, and,optionally, a compound of formula IV-a, wherein the compounds of formulaII and IV-a are present in amount of less than about 60, about 10, about5, about 3.3, about 2.5, or about 1 ppm total.

In certain embodiments, such compositions are formulated in a liquidformulation. In some embodiments, the present invention provides aliquid composition comprising a compound of formula II and a compound offormula II where the amount of compound of formula II in the compositionis less than about 25, about 100, about 125, about 150, about 185, about187, or about 190 ppm. In some embodiments, the present inventionprovides a composition comprising a compound of formula III, a compoundof formula II, and, optionally, a compound of formula IV-a, wherein thecompounds of formula II and IV-a, when present, are present in amount ofless than about 25, about 100, about 125, about 150, about 185, about187, or about 190 ppm total.

In other embodiments, the present invention provides a compositioncomprising:

(a) compound III-1:

(b) compound II-1:

and (c) optionally, compound IV-1:

In other embodiments, the present invention provides a solid compositioncomprising compound III-1, a II-1, and, optionally, compound IV-1,wherein at least about 99.6%, 99.7%, 99.8%, 99.85%, 99.9%, or 99.95% ofthe compound III-1 is in the (R) configuration with respect to nitrogenand compound II-1 is present in an amount of 60, 10, 5, 3.3, 2.5, 1 ppmor less. It other embodiments, the present invention provides acomposition comprising compound III-1, compound II-1, and, optionally,compound IV-1, wherein the compounds II-1 and IV-1 are present in amountof less than about 60, about 10, about 5, about 3.3, about 2.5, or about1 ppm total.

In some embodiments, the present invention provides a liquid compositioncomprising compound III-1 and compound II-1, wherein compound II-1 ispresent in amount of less than about 25, about 100, about 125, about150, about 185, about 187, or about 190 ppm. In some embodiments, thepresent invention provides a liquid composition comprising compoundIII-1, compound II-1, and, optionally, compound IV-1, wherein thecompounds II-1 and IV-1 are present in amount of less than about 25,about 100, about 125, about 150, about 185, about 187, or about 190 ppmtotal.

In certain embodiments, the present invention provides a prefilledsyringe comprising a liquid composition comprising methylnaltrexone.Nonlimiting examples of such liquid compositions are described in detailin United States published patent application number US 2008-0070975,the entirety of which is hereby incorporated herein by reference. Insome embodiments, the present invention provides a prefilled syringecomprising a unit dosage of a liquid composition which comprisesmethylnaltrexone or a pharmaceutically acceptable salt thereof, acalcium salt, and a chelating agent. In certain embodiments, the presentinvention provides a prefilled syringe, substantially free fromtungsten, comprising a unit dosage of a liquid composition whichcomprises methylnaltrexone, a calcium chelating agent, and a bufferingagent. In certain embodiments, the present invention provides aprefilled syringe, substantially free from tungsten, comprising a unitdosage of a liquid composition which comprises methylnaltrexone, acalcium chelating agent, a buffering agent, and an isotonicity agent. Insome embodiments, the present invention provides a prefilled syringe,substantially free from tungsten, comprising a unit dosage of a liquidcomposition which comprises methylnaltrexone bromide, edetate calciumdisodium, and glycine hydrochloride. In some embodiments, the presentinvention provides a prefilled syringe, substantially free fromtungsten, comprising a unit dosage of a liquid composition whichcomprises methylnaltrexone bromide, edetate calcium disodium, glycinehydrochloride, and sodium chloride.

In certain embodiments, the liquid composition has a pH of between aboutpH 2.0 and about pH 6.0. In some embodiments, the pH of the formulationis between about pH 2.6 and about pH 5.0. In some embodiments, the pH ofthe formulation is between about pH 3.0 and about pH 4.0. In someembodiments, the pH of the formulation is between about pH 3.4 and aboutpH 3.6. In some embodiments, the pH of the formulation is about pH 3.5.In certain embodiments, the liquid composition has a pH of about 2.5 toabout 6.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone in an amountfrom about 0.5 mg to about 200 mg, about 1 mg to about 80 mg, from about5 mg to about 40 mg, or methylnaltrexone bromide in an amount of about 8mg, about 12 mg, about 16 mg, about 18 mg, or about 24 mg.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone and achelating agent in an amount from about 0.01 mg/mL, to about 2 mg/mL orabout 0.1 mg/mL to about 1 mg/mL in the formulation, or about 0.2 mg/mLto about 0.8 mg/mL of the formulation. In some embodiments, a chelatingagent may be present in an amount from about 0.2 mg/mL, about 0.3 mg/mL,about 0.4 mg/mL, about 0.5 mg/mL, or about 0.6 mg/mL, in theformulation.

Exemplary chelating agents include ethylenediaminetetraacetic acid (alsosynonymous with EDTA, edetic acid, versene acid, and sequestrene), andEDTA derivatives, such as sodium EDTA, and potassium EDTA, diammoniumEDTA, dipotassium EDTA, disodium EDTA, TEA-EDTA, tetrasodium EDTA,tripotassium EDTA, trisodium EDTA, HEDTA, and trisodium HEDTA, andrelated salts thereof. Other chelating agents include niacinamide andderivatives thereof and sodium desoxycholate and derivatives thereof,ethylene glycol-bis-(2-aminoethyl)-N,N,N′,N′-tetraacetic acid (EGTA) andderivatives thereof, diethylenetriaminepentaacetic acid (DTPA) andderivatives thereof, N,N-bis(carboxymethyl)glycine (NTA) and derivativesthereof, nitrilotriacetic acid and derivatives thereof. Still otherchelating agents include citric acid and derivatives thereof. Citricacid also is known as citric acid monohydrate. Derivatives of citricacid include anhydrous citric acid and trisodiumcitrate-dihydrate. Insome embodiments, chelating agent is selected from EDTA or an EDTAderivative or EGTA or an EGTA derivative. In some embodiments chelatingagent is EDTA disodium such as, for example, EDTA disodium hydrate.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone and acalcium salt in an amount from about 0.01 mg/mL to about 2 mg/mL orabout 0.1 mg/mL to about 1 mg/mL, or about 0.2 mg/mL to about 0.8 mg/mL,about 0.2 mg/mL, about 0.3 mg/mL, about 0.4 mg/mL, about 0.5 mg/mL, orabout 0.6 mg/mL.

Examplary of calcium salts include, but are not limited to calciumchloride, calcium acetate, calcium citrate, calcium sulfate, etc.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone and acalcium salt chelating agent in an amount from about 0.01 mg/L to about2 mg/mL or about 0.1 mg/mL to about 1 mg/mL, or about 0.2 mg/mL to about0.8 mg/mL. In some embodiments, calcium salt chelating agent may bepresent in an amount from about 0.2 mg/mL, about 0.3 mg/mL, about 0.4mg/mL, about 0.5 mg/mL, or about 0.6 mg/mL.

Common calcium salt chelating agents include, but are not limited tocalcium ethylenediaminetetra acetic acid (EDTA) and calcium salt EDTAderivatives, calcium ethyleneglycol-bis-(2-aminoethyl)-N,N,N′,N′-tetraacetic acid (EGTA) and calciumsalt EGTA derivatives, calcium diethylenetriaminepentaacetic acid (DTPA)and calcium salt DTPA derivatives, calcium N,N-bis(carboxymethyl)glycine(NTA) and calcium salt NTA derivatives, and calcium citrate andderivatives thereof. In some embodiments, chelating agent is selectedfrom calcium EDTA or a calcium salt EDTA derivative or calcium EGTA or acalcium salt EGTA derivative. In some embodiments chelating agent iscalcium EDTA disodium such as, for example, calcium EDTA disodiumhydrate.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone and anisotonic agent. Common isotonic agents include agents selected from thegroup consisting of sodium chloride, mannitol, lactose, dextrose(hydrous or anhydrous), sucrose, glycerol, and sorbitol, and solutionsthereof.

In some embodiments, the present invention provides a prefilled syringecomprising a liquid composition comprising methylnaltrexone and astabilizing agent in an amount from about 0.01 mg/mL, to about 2 mg/mLor about 0.05 mg/mL, to about 1 mg/mL, or about 0.1 mg/mL to about 0.8mg/mL. In some embodiments, stabilizing agent may be present in anamount from about 0.15 mg/mL, about 0.2 mg/mL, about 0.25 mg/mL, about0.3 mg/mL, about 0.35 mg/mL, or about 0.4 mg/mL.

Exemplary stabilizing agents include glycine, benzoic acid, citric,glycolic, lactic, malic, and maleic acid. In some embodiments, theformulation comprises glycine. In some embodiments, glycine comprisesglycine-HCl.

In certain embodiments, the present invention provides a prefilledsyringe comprising a liquid composition comprising a compound of formulaIII and a compound of formula II, wherein the compound of formula II ispresent in amount of less than about 25, about 100, about 125, about150, about 185, about 187, or about 190 ppm. In some embodiments, thepresent invention provides a liquid composition comprising a compound offormula III, a compound of formula II, and, optionally, a compound offormula IV, wherein the compounds of formulae II and IV are present inamount of less than about 25, about 100, about 125, about 150, about185, about 187, or about 190 ppm total.

In some embodiments, a syringe, for use in preparing prefilled syringesin accordance with the present invention, is “tungsten free” or“substantially free” from tungsten. In some embodiments, a “tungstenfree” or substantially free from tungsten syringe is commerciallyavailable from Becton. Dickinson, Schott, and others. Such syringes maybe referred to as “Ultra Low” Tungsten Syringes or “tungsten free”.

In certain embodiments, “substantially free” from tungsten means a levelof tungsten less than an amount that contributes to degradation of acompound of formula III. In certain embodiments, a syringe that issubstantially free from tungsten contains tungsten in an amount of lessthan about 60 parts per billion, or less than about 50 parts perbillion, or less than about 40 parts per billion. In some embodiments, asyringe that is substantially free from tungsten contains tungsten in anamount of less than about 12 parts per billion. It will be appreciatedthat syringes designated as “substantially free” from tungsten includethose that are tungsten free. Levels of tungsten in the syringe can bemeasured by variety of techniques known to those skilled in the art suchas those described in US 20080103438 and, in more detail, in Example 8,infra.

In some embodiments a syringe for use in preparing prefilled syringes inaccordance with the present invention is a prefilable glass and/orpolymer syringe. Such syringes are commercially available, for example,from Schott. In some embodiments, the polymer syringe is made ofcycloolefin polymer.

Without wishing to be bound by any particular theory, it is believedthat the presence of tungsten in a syringe contributes to thedegradation of methylnaltrexone solution stored in such a syringe. Suchdegradation includes formation of a compound of formula I. Thus, in someaspects of the present invention, a methylnaltrexone solution is storedin a manner whereby the solution is isolated from tungsten (i.e.,methylnaltrexone is not in contact with tungsten). In certainembodiments, the present invention provides a methylnaltrexone prefilledsyringe that is free from tungsten, or a derivative thereof, or containstungsten in an amount of less than about 60 parts per billion or lessthan about 50 parts per billion or less than about 40 parts per billionor less than about 12 parts per billion. Levels of tungsten can bemeasured for example by ICP-MS.

In certain embodiments, the present invention provides a prefilledsyringe, substantially free from tungsten, comprising a liquidcomposition comprising compound III-1 and compound II-1, whereincompound II-1 is present in amount of less than about 25, about 100,about 125, about 150, about 185, about 187, or about 190 ppm. In someembodiments, the present invention provides a prefilled syringe,substantially free from tungsten, liquid composition comprising compoundII-1, compound II-1, and, optionally, compound IV-1, wherein thecompounds II-1 and IV-1 are present in amount of less than about 25,about 100, about 125, about 150, about 185, about 187, or about 190 ppmtotal.

In some embodiments, the present invention provides a prefilled syringe,substantially free from tungsten, comprising a liquid compositioncomprising about 8 mg of compound III-1 in about 0.4 mL water, andcompound II-1, wherein compound II-1 is present in amount of less thanabout 25, about 100, about 125, about 150, about 185, about 187, orabout 190 ppm. In certain embodiments, the present invention provides aprefilled syringe, substantially free from tungsten, comprising: (a) 8mg of compound III-1; (b) 0.16 mg edetate calcium disodium; and (c) 0.12mg glycine hydrochloride, wherein said prefilled syringe comprisescompound II-1 in an amount of less than about 25, about 100, about 125,about 1.50, about 185, about 187, or about 190 ppm. In certainembodiments, the present invention provides a prefilled syringe,substantially free from tungsten, comprising: (a) 8 mg of compoundIII-1; (b) 0.4 mL water; (c) 2.6 mg sodium chloride; (d) 0.16 mg edetatecalcium disodium; and (e) 0.12 mg glycine hydrochloride, wherein saidprefilled syringe comprises compound II-1 in an amount of less thanabout 25, about 100, about 125, about 1.50, about 185, about 187, orabout 190 ppm.

In some embodiments, the present invention provides a prefilled syringe,substantially free from tungsten, comprising a liquid compositioncomprising about 12 mg of compound III-1 in about 0.6 mL water, andcompound II-1, wherein compound II-1, is present in amount of less thanabout 25, about 100, about 125, about 150, about 185, about 187, orabout 190 ppm. In certain embodiments, the present invention provides aprefilled syringe, substantially free from tungsten, comprising: (a) 12mg of compound III-1; (b) 0.24 mg edetate calcium disodium; and (c) 0.18mg glycine hydrochloride, wherein said prefilled syringe comprisescompound II-1 in an amount of less than about 25, about 100, about 125,about 150, about 185, about 187, or about 190 ppm. In certainembodiments, the present invention provides a prefilled syringe,substantially free from tungsten, comprising: (a) 12 mg of compoundII-1; (b) 0.6 mL water; (c) 3.9 mg sodium chloride; (d) 0.24 mg edetatecalcium disodium; and (e) 0.18 mg glycine hydrochloride, wherein saidprefilled syringe comprises compound II-1 in an amount of less thanabout 25, about 100, about 125, about 150, about 185, about 187, orabout 190 ppm.

In some embodiments, one or more provided prefilled syringes that aresubstantially free from tungsten and contains methylnaltrexone, asdescribed herein, are stored in a container that shields the syringefrom light. In certain embodiments, one or more prefilled syringes arestored in a blister pack which shields the syringes from light. In someembodiments, one or more prefilled syringes are stored in a box whichshields the syringe from light.

In some embodiments, a prefilled syringe, that is substantially freefrom tungsten and contains methylnaltrexone, as described herein,provides a unit dosage of methylnaltrexone that is stable to degradationunder typical ambient storage conditions for at least 9 months or atleast 12 months, or at least 18 months or at least 24 months. As usedherein, the term “typical ambient storage conditions” refers to 25°C./60% RH. In certain embodiments, the present invention provides aprefilled syringe, as described herein, wherein said prefilled syringecomprises compound II-1 in an amount of less than about 25 ppm for atleast 9 months, at least 12 months, at least 14 months, at least 16months, at least 18 months, or at least 24 months. In certainembodiments, the present invention provides a prefilled syringe, asdescribed herein, wherein said prefilled syringe comprises compoundsII-1 and/or IV-1 in an amount of less than about 25, about 100, about125, about 150, about 1.85, about 187, or about 190 ppm total for atleast 9 months, at least 12 months, at least 14 months, at least 16months, at least 18 months, or at least about 24 months.

In certain embodiments, the present invention provides compound II-1 asa crystalline solid. In some embodiments, compound II-1 is provided asan amorphous solid.

As used herein, the term “substantially free of amorphous compound II-1”means that the crystalline solid contains no significant amount ofamorphous compound II-1. In certain embodiments of the presentinvention, the term “substantially free of amorphous compound II-1”means that at least about 95% by weight of compound II-1 in the solid isin crystalline form. In certain embodiments of the invention, the term“substantially free of amorphous compound II-1” means that at leastabout 99% by weight of Compound 1 in the solid is in crystalline form.

As used herein, the term “substantially free of other forms of compoundII-1” means that the solid contains no significant amount of anothersolid form of compound II-1. In certain embodiments of the presentinvention, the term “substantially free of other forms of compound II-1”means that at least about 95% by weight of compound II-1 is in thespecified solid form. In certain embodiments of the invention, the term“substantially free of another form of compound II-1” means that atleast about 99% by weight of compound II-1 is in the specified solidform.

The powder XRD of compound II-1 polymorph contained peaks at 9.8, 10.8,12.7, 14.7, 15.0, 15.9, 16.7, 17.5, 18.7, 19.4, 20.5, 21.0, 21.7, 22.6,23.0, 24.3, 24.8, 25.5, 25.9, 26.8, 27.2, 28.2, 28.8, 29.5, 30.1, 31.2,32.1, 32.9, 33.5, 34.9, 36.0 and 38.5 degrees 2 theta. In certainembodiments, the present invention provides a crystalline form ofcompound II-1 characterized in that said form has one or more peaks inits powder X-ray diffraction pattern selected from 9.8, 10.8, 12.7,14.7, 15.0, 15.9, 16.7, 17.5, 18.7, 19.4, 20.5, 21.0, 21.7, 22.6, 23.0,24.3, 24.8, 25.5, 25.9, 26.8, 27.2, 28.2, 28.8, 29.5, 30.1, 31.2, 32.1,32.9, 33.5, 34.9, 36.0 and 38.5 degrees 2 theta. In certain embodiments,the present invention provides a crystalline form of compound II-1characterized in that said form has two or more peaks in its powderX-ray diffraction pattern selected from 9.8, 10.8, 12.7, 14.7, 15.0,15.9, 16.7, 17.5, 18.7, 19.4, 20.5, 21.0, 21.7, 22.6, 23.0, 24.3, 24.8,25.5, 25.9, 26.8, 27.2, 28.2, 28.8, 29.5, 30.1, 31.2, 32.1, 32.9, 33.5,34.9, 36.0 and 38.5 degrees 2 theta. In certain embodiments, the presentinvention provides a crystalline form of compound II-1 characterized inthat said form has substantially all of the peaks in its powder X-raydiffraction pattern selected from 9.8, 10.8, 12.7, 14.7, 15.0, 15.9,16.7, 17.5, 18.7, 19.4, 20.5, 21.0, 21.7, 22.6, 23.0, 24.3, 24.8, 25.5,25.9, 26.8, 27.2, 28.2, 28.8, 29.5, 30.1, 31.2, 32.1, 32.9, 33.5, 34.9,36.0 and 38.5 degrees 2 theta.

According to one aspect, compound II-1 polymorph has an XRD patterncontaining substantially all of the peaks depicted in FIG. 15. As usedherein, the phrase “substantially all of the peaks” means that thecompound exhibits, in its XFD, at least about 80% of the peaks listed.In other embodiments, the phrase “substantially all of the peaks” meansthat the compound exhibits, in its XRD, at least about 85, 90, 95, 97,98, or 99% of the peaks listed.

According to another embodiment, the present invention provides compoundII-1 as an amorphous solid. Amorphous solids are well known to one ofordinary skill in the art and are typically prepared by such methods aslyophilization, melting, and precipitation from supercritical fluid,among others. Methods of preparing amorphous compound II-1 are describedin the Examples section, infra.

In certain embodiments, the present invention provides amorphouscompound II-1 substantially free of crystalline compound II-1. As usedherein, the term “substantially free of crystalline compound II-1” meansthat the compound contains no significant amount of crystalline compoundII-1. In certain embodiments of the present invention, at least about95% by weight of compound II-1 present is amorphous compound II-1. Instill other embodiments of the invention, at least about 99% by weightof compound II-1 present is amorphous compound II-1.

In other embodiments, the present invention provides a compositioncomprising amorphous compound II-1 and at least one crystalline form ofcompound II-1. Such crystalline forms of compound II-1 include compoundII-1 polymorph as described herein or other crystalline forms ofcompound II-1 that may result from the preparation of, and/or isolationof, amorphous compound II-1. In certain embodiments, the presentinvention provides a composition comprising amorphous compound II-1 andat least one crystalline form of compound II-1 as described herein.

In some embodiments, the present invention provides a method comprisingthe steps of:

(a) providing a compound of formula III:

wherein A⁻ is a suitable anion; and(b) treating the compound of formula III with an oxidizing agent to forma compound of formula II:

wherein X⁻ is a suitable anion.

Oxidizing agents suitable for the reaction with a compound of formulaIII to form a compound of formula II are well known to one of ordinaryskill in the art. In some embodiments, the oxidizing agent is aperoxide, a benzoquinone, or a peracid. In certain embodiments, theoxidizing agent is hydrogen peroxide, t-butyl hydrogen peroxide, MCPBA(meta-chloroperbenzoic acid), peracetic acid, oxone (potassiumperoxymonosulfate), or DDQ (2,3-dichloro-5,6-dicyanobenzoquinone).

In certain embodiments, the present invention provides a methodcomprising the steps of:

(a) providing compound III-1:

and(b) treating the compound III-1 with an oxidizing agent to form compoundII-1:

In some embodiments, the method for preparing compound II-1 from III-1,via oxidation reaction, further comprises the step of performing a saltexchange to afford compound II-3:

One of ordinary skill in the art will appreciate that compound II-3 isreadily prepared from compound II-1 by, for example, HPLC purificationutilizing an eluent that contains trifluoroacetic acid.

4. Uses, Formulation and Administration

Compound II-1 was identified as a new degradation product of(R)—N-methylnaltrexone bromide. Specifically, a stability studyperformed on (R)—N-methylnaltrexone bromide pre-filled syringes resultedin a new, unknown impurity. This impurity was identified by LC/MS as anew peak eluting at RRT 0.60. The peak was isolated by preparative HPLC,as detailed at Example 1. One of ordinary skill in the art wouldrecognize that the compound of formula II isolated from the preparativeHPLC, using the solvent eluent as described in the Exemplification, wasthe trifluoroacetic acid salt, compound II-3. In addition, compound II-1was synthesized to confirm its structural identity. Thus, compounds ofthe present invention are useful as analytical standards for use indetermining the purity of (R)—N-methylnaltrexone bromide as an activepharmaceutical ingredient.

In certain embodiments, the present invention provides a methodcomprising the steps of

-   -   (a) providing a sample of (R)—N-methylnaltrexone bromide;    -   (b) performing an analysis of the sample of        (R)—N-methylnaltrexone bromide; and    -   (c) determining the amount of compound II-1 in the sample of        (R)—N-methylnaltrexone bromide.

In certain embodiments, the present invention pro vides a methodcomprising the steps of:

-   -   (a) providing a sample of (R)—N-methylnaltrexone bromide;    -   (b) performing an analysis of the sample of        (R)—N-methylnaltrexone bromide; and    -   (c) determining the amount of compound II-1 and compound IV in        the sample of (R)—N-methylnaltrexone bromide.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (a) providing a sample of (R)—N-methylnaltrexone bromide;    -   (b) providing a sample of compound II-1; and    -   (c) performing HPLC analysis of the sample of        (R)—N-methylnaltrexone bromide and the sample of compound II-1;        and    -   (d) determining the amount of compound II-1 in the sample of        (R)—N-methylnaltrexone bromide.

In certain embodiments, step (d) comprises determining that the amountof compound II-1 (or compound II-3, as appropriate) in the sample of (R)—-methylnaltrexone bromide is less than about 60 ppm, about 10 ppm,about 5 ppm, about 3.3 ppm, about 2.5 ppm, or about 1.0 ppm. In someembodiments, step (d) comprises determining that the amount of compoundII-1 (or compound II-3, as appropriate) in the sample of(R)—N-methylnaltrexone bromide is less than about 25, about 100, about125, about 150, about 185, about 187, or about 190 ppm.

in some embodiments, the present invention provides a method comprisingthe steps of:

-   -   (a) providing an HPLC chromatogram of a sample of        (R)—N-methylnaltrexone bromide;    -   (b) providing an HPLC chromatogram of a sample of compound II-1;    -   (c) comparing the HPLC chromatograms and determining the amount        of compound II-1 in the sample of (R)—N-methylnaltrexone        bromide.

In certain embodiments, step (c) comprises determining that the amountof compound II-1 (or compound II-3, as appropriate) in the sample of(R)—N-methylnaltrexone bromide is less than about 60 ppm, about 10 ppm,about 5 ppm, about 3.3 ppm, about 2.5 ppm, or about 1.0 ppm. In someembodiments, step (c) comprises determining that the amount of compoundII-1 (or compound II-3, as appropriate) in the sample of(R)—N-methylnaltrexone bromide is less than about 25, about 100, about125, about 150, about 185, about 187, or about 190 ppm.

In certain embodiments, step (b) further comprises providing a sample ofcompound IV-1 and step (e) further comprises determining the amount ofcompound IV-1 in the sample of (R)—N-methylnaltrexone bromide. Incertain embodiments, step (e) comprises determining that the amount ofcompound II-1 and compound IV-1 in the sample of (R)—N-methylnaltrexonebromide is less than about 60 ppm, about 10 ppm, about 5 ppm, about 3.3ppm, about 2.5 ppm, or about 1 ppm total. In certain embodiments, step(c) comprises determining that the amount of compound II-1 and compoundIV-1 in the sample of (R)—N-methylnaltrexone bromide is less than about25, about 100, about 125, about 150, about 185, about 187, or about 190ppm.

In some embodiments, step (c) comprises determining that the sample of(R)—N-methylnaltrexone bromide provides no more than 1.5 micrograms ofcompound II-1 and compound IV-1 per dose (i.e., per day).

In certain embodiments, compounds of the present invention are usefulfor the study of peripheral mu opioid antagonists in biological andpathological phenomena and the comparative evaluation of peripheral muopioid antagonists.

In certain embodiments, a compound of formula I is useful as aperipheral mu opioid receptor antagonist. According to another aspect ofthe present invention, pharmaceutically acceptable compositions areprovided, comprising a compound of formula I, as described herein, andoptionally comprising a pharmaceutically acceptable carrier, adjuvant,or vehicle. In certain embodiments of the present invention, suchpharmaceutically acceptable compositions optionally further comprise oneor more additional therapeutic agents.

As described above, the pharmaceutically acceptable compositions of thepresent invention additionally comprise a pharmaceutically acceptablecarrier, adjuvant, or vehicle, which, as used herein, includes any andall solvents, diluents, or other liquid vehicle, dispersion orsuspension aids, surface active agents, isotonic agents, thickening oremulsifying agents, preservatives, solid binders, lubricants and thelike, as suited to the particular dosage form desired. RemingtonsPharmaceutical Sciences, 17th edition, ed. Alfonoso R. Gennaro, MackPublishing Company, Easton, Pa. (1985) discloses various carriers usedin formulating pharmaceutically acceptable compositions and knowntechniques for the preparation thereof. Except insofar as anyconventional carrier medium is incompatible with the salt of theinvention, such as by producing any undesirable biological effect orotherwise interacting in a deleterious manner with any othercomponent(s) of the pharmaceutically acceptable composition, its use iscontemplated to be within the scope of this invention. Some examples ofmaterials which can serve as pharmaceutically acceptable carriersinclude, but are not limited to, ion exchangers, alumina, aluminumstearate, lecithin, serum proteins, such as human serum albumin, buffersubstances such as phosphates, glycine, sorbic acid, or potassiumsorbate, partial glyceride mixtures of saturated vegetable fatty acids,water, salts or electrolytes, such as protamine sulfate, disodiumhydrogen phosphate, potassium hydrogen phosphate, sodium chloride, zincsalts, colloidal silica, magnesium trisilicate, polyvinyl pyrrolidone,polyacrylates, waxes, polyethylene-polyoxypropylene-block polymers, woolfat, sugars such as lactose, glucose and sucrose; starches such as cornstarch and potato starch; cellulose and its derivatives such as sodiumcarboxymethyl cellulose, ethyl cellulose and cellulose acetate; powderedtragacanth; malt; gelatin; talc; excipients such as cocoa butter andsuppository waxes; oils such as peanut oil, cottonseed oil; saffloweroil; sesame oil; olive oil; corn oil and soybean oil; glycols; such apropylene glycol or polyethylene glycol; esters such as ethyl oleate andethyl laurate; agar; buffering agents such as magnesium hydroxide andaluminum hydroxide; alginic acid; pyrogen free water; isotonic saline;Ringer's solution; ethyl alcohol, and phosphate buffer solutions, aswell as other non-toxic compatible lubricants such as sodium laurylsulfate and magnesium stearate, as well as coloring agents, releasingagents, coating agents, sweetening, flavoring and perfuming agents,preservatives and antioxidants can also be present in the composition,according to the judgment of the formulator.

In certain embodiments, the invention relates to compositions comprisingat least one compound of formula I and one or more pharmaceuticallyacceptable carriers, excipients, or diluents. Such compositions areprepared in accordance with acceptable pharmaceutical procedures, suchas, for example, those described in Remingtons, which is incorporatedherein by reference in its entirety. Pharmaceutically acceptablecarriers are those carriers that are compatible with the otheringredients in the formulation and are biologically acceptable.

The compositions of the present invention are administered orally orparenterally, neat, or in combination with conventional pharmaceuticalcarriers. Applicable solid carriers can include one or more substancesthat can also act as flavoring agents, lubricants, solubilizers,suspending agents, fillers, glidants, compression aids, binders,tablet-disintegrating agents, or encapsulating materials. In powders,the carrier is a finely divided solid that is in admixture with thefinely divided active ingredient. In tablets, the active ingredient ismixed with a carrier having the necessary compression properties insuitable proportions and compacted in the shape and size desired.Suitable solid carriers include, for example, calcium phosphate,magnesium stearate, talc, sugars, lactose, dextrin, starch, gelatin,cellulose, methyl cellulose, sodium carboxymethyl cellulose,polyvinylpyrrolidine, low melting waxes and ion exchange resins.

Liquid carriers can be used in preparing solutions, suspensions,emulsions, syrups and elixirs. The active ingredient can be dissolved orsuspended in a pharmaceutically acceptable liquid carrier such as water,an organic solvent, a mixture of both, or a pharmaceutically acceptableoil or fat. The liquid carrier can contain other suitable pharmaceuticaladditives such as, for example, solubilizers, emulsifiers, buffers,preservatives, sweeteners, flavoring agents, suspending agents,thickening agents, colors, viscosity regulators, stabilizers orosmo-regulators. Suitable examples of liquid carriers for oral andparenteral administration include water (particularly containingadditives as above, e.g. cellulose derivatives, preferably sodiumcarboxymethyl cellulose solution), alcohols (including monohydricalcohols and polyhydric alcohols e.g. glycols) and their derivatives,and oils (e.g. fractionated coconut oil and arachis oil). For parenteraladministration, the carrier can also be an oily ester such as ethyloleate and isopropyl myristate. Sterile liquid carriers are used insterile liquid form compositions for parenteral administration. Theliquid carrier for pressurized compositions can be halogenatedhydrocarbon or other pharmaceutically acceptable propellant.

Liquid pharmaceutical compositions that are sterile solutions orsuspensions can be administered by, for example, intramuscular,intraperitoneal or subcutaneous injection. Sterile solutions can also beadministered intravenously. Compositions for oral administration can bein either liquid or solid form.

In certain embodiments, the compositions of the present invention areadministered rectally or vaginally in the form of a conventionalsuppository. For administration by intranasal or intrabronchialinhalation or insufflation, the compositions of the present inventioncan be formulated into an aqueous or partially aqueous solution, whichcan then be utilized in the form of an aerosol. The compositions of thepresent invention can also be administered transdermally through the useof a transdermal patch containing the active compound and a carrier thatis inert to the active compound, is non-toxic to the skin, and allowsdelivery of the agent for systemic absorption into the blood stream viathe skin. The carrier can take any number of forms such as creams andointments, pastes, gels, and occlusive devices. The creams and ointmentscan be viscous liquid or semisolid emulsions of either the oil-in-wateror water-in-oil type. Pastes comprised of absorptive powders dispersedin petroleum or hydrophilic petroleum containing the active ingredientcan also be suitable. A variety of occlusive devices can be used torelease the active ingredient into the blood stream such as asemipermeable membrane covering a reservoir containing the activeingredient with or without a carrier, or a matrix containing the activeingredient. Other occlusive devices are known in the literature.

In some embodiments, the pharmaceutical composition is in unit dosageform, e.g. as tablets, capsules, powders, solutions, suspensions,emulsions, granules, or suppositories. In such form, the composition issub-divided in unit dose containing appropriate quantities of the activeingredient; the unit dosage forms can be packaged compositions. Forexample, packeted powders, vials, ampoules, prefilled syringes orsachets containing liquids. The unit dosage form can be, for example, acapsule or tablet itself, or it can be the appropriate number of anysuch compositions in package form.

The amount of composition of the present invention provided to a subjectwill vary depending upon what is being administered, the purpose of theadministration, such as prophylaxis or therapy, the state of thesubject, the manner of administration, and the like. In therapeuticapplications, compositions of the present invention are provided to asubject suffering from a condition in an amount sufficient to treat orat least partially treat the symptoms of the condition and itscomplications. An amount adequate to accomplish this is a“therapeutically effective amount” as described previously herein. Thedosage to be used in the treatment of a specific case must besubjectively determined by the attending physician. The variablesinvolved include the specific condition and the size, age, and responsepattern of the subject. The treatment of substance abuse follows thesame method of subjective drug administration under the guidance of theattending physician. Generally, a starting dose is about mg per day withgradual increase in the daily dose to about 150 mg per day, to providethe desired dosage level in the subject.

In some embodiments, the present invention provides a method comprisingadministering to a subject an 8 mg or 12 mg dose of a compound offormula III via subcutaneous injection. In certain embodiments, thepresent invention provides a method comprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising 8 mg of compound III-1 and compound II-1, wherein        compound II-1 is present in amount of less than about 25, about        100, about 125, about 150, about 185, about 187, or about 190        ppm and/or where the amount of compound II-1 and compound IV-1        is present in amount of less than about 25, about 100, about        125, about 150, about 185, about 187, or about 190 ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising 8 mg of compound III-1 in 0.4 mL water, and compound        II-1, wherein compound II-1 is present in amount of less than        about 25, about 100, about 125, about 150, about 185, about 187,        or about 190 ppm and/or where the amount of compound II-1 and        compound IV-1 is present in amount of less than about 25, abbot        100, about 125, about 150, about 185, about 187, or about 190        ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the stops of

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising: (a) 8 mg of compound III-1; (b) 0.16 mg edetate        calcium disodium; and (c) 0.12 mg glycine hydrochloride, wherein        said prefilled syringe comprises compound II-1 in an amount of        less than about 25, about 100, about 125, about 150, about 185,        about 187, or about 190 ppm and/or where the amount of compound        II-1 and compound IV-1 is present in amount of less than about        25, about 100, about 125, about 150, about 185, about 187, or        about 190 ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a composition        comprising: (a) 8 mg of compound II-1; (b) 0.4 mL water; (c) 2.6        mg sodium chloride; (d) 0.16 mg edetate calcium disodium;        and (e) 0.12 mg glycine hydrochloride, wherein said prefilled        syringe comprises compound II-1 in an amount of less than about        25, about 100, about 125, about 150, about 185, about 187, or        about 190 ppm and/or where the amount of compound II-1 and        compound IV-1 is present in amount of less than about 25, about        100, about 125, about 150, about 185, about 187, or about 190        ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising 12 mg of compound III-1 and compound II-1, wherein        compound II-1 is present in amount of less than about 25, about        100, about 125, about 150, about 185, about 187, or about 190        ppm and/or where the amount of compound II-1 and compound IV-1        is present in amount of less than about 25, about 100, about        125, about 150, about 185, about 187, or about 190 ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising 12 mg of compound III-1 in 0.6 mL water, and compound        II-1, wherein compound II-1 is present in amount of less than        about 25, about 100, about 125, about 150, about 185, about 187,        or about 190 ppm and/or where the amount of compound II-1 and        compound IV-1 is present in amount of less than about 25, about        100, about 125, about 150, about 185, about 187, or about 190        ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, the present invention provides a methodcomprising the steps of:

-   -   (i) providing a prefilled syringe, substantially free from        tungsten, comprising a unit dosage of a liquid composition        comprising: (a) 12 mg of compound III-1; (b) 0.24 mg edetate        calcium disodium; and (c) 0.18 mg glycine hydrochloride, wherein        said prefilled syringe comprises compound II-1 in an amount of        less than about 25, about 100, about 125, about 150, about 185,        about 187, or about 190 ppm and/or where the amount of compound        II-1 and compound IV-1 is present in amount of less than about        25, about 100, about 125, about 150, about 185, about 187, or        about 190 ppm in total;    -   (ii) administering the unit dosage to a subject via subcutaneous        injection.

In certain embodiments, a subject weighs between about 62 and about 114kg. In some embodiments, the subject is suffering from opioid inducedconstipation, including but not limited to, for example, subjects whoare terminally ill or suffer from chronic pain.

In other embodiments of the present invention, the compositions containa compound of either of formula I or II, in an amount of at least about97, 97.5, 98, 98.5, 99, 99.5, 99.8 weight percent where the percentagesare based on the free base of said compound and on the total weight ofthe composition. In other embodiments, the composition containing acompound of either of formula I or II contains no more than about 2.0area percent HPLC of total organic impurities and more preferably nomore than about 1.5 area percent HPLC total organic impurities relativeto the total area of the HPLC chromatogram.

In other embodiments of the present invention, a composition is providedcomprising a compound of formula III, at least one compound of formula Ior II, and at last one pharmaceutically acceptable carrier. In someembodiments, such compositions contain a compound of formula I or II inan amount of about 1 weight percent to about 99 weight percent, wherethe percentages are based on the free base of said compound and on thetotal weight of the composition. In other embodiments, the compositioncontaining a compound of formula I or II contains no more than about 2.0area percent HPLC of total organic impurities and more preferably nomore than about 1.5 area percent HPLC total organic impurities relativeto the total area of the HPLC chromatogram.

In certain embodiments, the present invention is directed to acomposition, as described herein, comprising a prodrug of a compound offormula I. The term “prodrug,” as used herein, means a compound that isconvertible in vivo by metabolic means (e.g. by hydrolysis) to acompound of formula I. Various forms of prodrugs are known in the artsuch as those discussed in, for example, Bundgaard, (ed.), Design ofProdrugs, Elsevier (1985); Widder, et al. (ed.), Methods in Enzymology,vol. 4, Academic Press (1985); Krogsgaard-Larsen, et al., (ed). “Designand Application of Prodrugs, Textbook of Drug Design and Development,Chapter 5, 1.13-191 (1991), Bundgaard, et al., Journal of Drug DeliveryReviews, 8:1-38 (1992), Bundgaard, J. of Pharmaceutical Sciences, 77:285et seq. (1988); and Higuchi and Stella (eds.) Prodrugs as Novel DrugDelivery Systems, American Chemical Society (1975), each of which ishereby incorporated by reference in its entirety,

Combination Products and Combined Administration

In certain embodiments, inventive compositions, and formulationsthereof, may be administered alone to treat one or more disorders asdescribed herein, or alternatively may be administered in combinationwith (whether simultaneously or sequentially) one or more other activeagents useful to treat one or more disorders as described herein. Thus,an inventive composition, or formulation thereof, can be administeredconcurrently with, prior to, or subsequent to, one or more activeagents.

In certain embodiments, inventive compositions include one or more otheractive agents in addition to a compound of formula I that is not acompound of formula I. In certain embodiments, the present inventionprovides a formulation that delivers a compound of formula I and atleast one additional active agent.

In some embodiments, inventive formulations comprise both an opioid anda compound of formula I. Such combination products, containing both anopioid and a compound of formula I would allow simultaneous relief ofpain and minimization of opioid-associated side effects (e.g.,gastrointestinal effects (e.g., delayed gastric emptying, altered GItract motility), etc.).

Opioids useful in treatment of analgesia are known in the art. Forexample, opioid compounds include, but are not limited to, alfentanil,anileridine, asimadoline, bremazocine, buprenorphine, butorphanol,codeine, dezocine, diacetylmorphine (heroin), dihydrocodeine,diphenoxylate, ethylmorphine, fedotozine, fentanyl, funaltrexamine,hydrocodone, hydromorphone, levallorphan, levomethadyl acetate,levorphanol, loperamide, meperidine (pethidine), methadone, morphine,morphine-6-glucuronide, nalbuphine, nalorphine, nicomorphine, opium,oxycodone, oxymorphone, papaveretum, pentazocine, propiram,propoxyphene, remifentanyl, sufentanil, tilidine, trimebutine, andtramadol. In some embodiments the opioid is at least one opioid selectedfrom alfentanil, buprenorphine, butorphanol, codeine, dezocine,dihydrocodeine, fentanyl, hydrocodone, hydromorphone, levorphanol,meperidine (pethidine), methadone, morphine, nalbuphine, nicomorphine,oxycodone, oxymorphone, papaveretum, pentazocine, propiram,propoxyphene, sufentanil and/or tramadol. In certain embodiments of thepresent invention, the opioid is selected from morphine, codeine,oxycodone, hydrocodone, dihydrocodeine, propoxyphene, fentanyl,tramadol, and mixtures thereof. In a particular embodiment, the opioidis loperamide. In other embodiments, the opioid is a mixed agonist suchas butorphanol. In some embodiments, the subjects are administered morethan one opioid, for example, morphine and heroin or methadone andheroin.

The amount of additional active agent(s) present in combinationcompositions of this invention will typically be no more than the amountthat would normally be administered in a composition comprising thatactive agent as the only therapeutic agent. In certain embodiments ofthe present invention, the amount of additional active agent will rangefrom about 50% to 100% of the amount normally present in a compositioncomprising that compound as the only therapeutic agent.

In certain embodiments, inventive formulations may also be used inconjunction with and/or in combination with conventional therapies forgastrointestinal dysfunction to aid in the amelioration of constipationand bowel dysfunction. For example, conventional therapies include, butmay not be limited to functional stimulation of the intestinal tract,stool softening agents, laxatives (e.g., diphelymethane laxatives,cathartic laxatives, osmotic laxatives, saline laxatives, etc), bulkforming agents and laxatives, lubricants, intravenous hydration, andnasogastric decompression.

Uses and Kits of Inventive Formulations

As discussed above, the present invention provides compounds andcompositions useful in antagonizing undesirable side effects of opioidanalgesic therapy (e.g., gastrointestinal effects (e.g. delayed gastricemptying, altered GI tract motility), etc.). Furthermore, a providedcompound or composition may be used as to treat subjects having diseasestates that are ameliorated by binding μ opioid receptors, or in anytreatment wherein temporary suppression of the μ opioid receptor systemis desired (e.g., ileus, etc.). In certain embodiments of the presentinvention, methods of use of formulations are in human subjects.

Accordingly, administration of provided compound or composition may beadvantageous for treatment, prevention, amelioration, delay or reductionof side effects of opioid use, such as, for example, gastrointestinaldysfunction (e.g., inhibition of intestinal motility, constipation, GIsphincter constriction, nausea, emesis (vomiting), biliary spasm, opioidbowel dysfunction, colic, dysphoria, pruritus, urinary retention,depression of respiration, papillary constriction, cardiovasculareffects, chest wall rigidity and cough suppression, depression of stressresponse, and immune suppression associated with use of narcoticanalgesia, etc, or combinations thereof. Use of a provided compound orcomposition may thus be beneficial from a quality of life standpoint forsubjects receiving opioids, as well as to reduce complications arisingfrom chronic constipation, such as hemorrhoids, appetite suppression,mucosal breakdown, sepsis, colon cancer risk, and myocardial infarction.

In some embodiments, a provided compound or composition is useful foradministration to a subject receiving acute opioid administration. Insome embodiments, a provided compound or composition is useful foradministration to subjects suffering from post-operativegastrointestinal dysfunction.

In other embodiments, a provided compound or composition is also usefulfor administration to subjects receiving chronic opioid administration(e.g., terminally ill patients receiving opioid therapy such as an AIDSpatient, a cancer patient, a cardiovascular patient; subjects receivingchronic opioid therapy for pain management; subjects receiving opioidtherapy for maintenance of opioid withdrawal). In some embodiments, thesubject is a subject using opioid for chronic pain management. In someembodiments, the subject is a terminally ill patient. In otherembodiments the subject is a person receiving opioid withdrawalmaintenance therapy.

Alternative or additional uses for a provided compound or compositionmay be to treat, reduce, inhibit, or prevent effects of opioid useincluding, e.g., aberrant migration or proliferation of endothelialcells (e.g., vascular endothelial cells), increased angiogenesis, andincrease in lethal factor production from opportunistic infectiousagents (e.g., Pseudomonas aeruginosa). Additional advantageous uses of aprovided compound or composition include treatment of opioid-inducedimmune suppression, inhibition of angiogenesis, inhibition of vascularproliferation, treatment of pain, treatment of inflammatory conditionssuch as inflammatory bowel syndrome, treatment of infectious diseasesand diseases of the musculoskeletal system such as osteoporosis,arthritis, osteitis, periostitis, myopathies, and treatment ofautoimmune diseases.

In certain embodiments, a provided compound or composition may be usedin methods for preventing, inhibiting, reducing, delaying, diminishingor treating gastrointestinal dysfunction, including, but not limited to,irritable bowel syndrome, opioid-induced bowel dysfunction, colitis,post-operative or postpartum ileus, nausea and or vomiting, decreasedgastric motility and emptying, inhibition of the stomach, and smalland/or large intestinal propulsion, increased amplitude ofnon-propulsive segmental contractions, constriction of sphincter ofOddi, increased anal sphincter tone, impaired reflex relaxation withrectal distention, diminished gastric, biliary, pancreatic or intestinalsecretions, increased absorption of water from bowel contents,gastro-esophageal reflux, gastroparesis, cramping, bloating, abdominalor epigastric pain and discomfort, constipation, idiopathicconstipation, post-operative gastrointestinal dysfunction followingabdominal surgery (e.g., colectomy (e.g., right hemicolectomy lefthemicolectomy, transverse hemicolectomy, colectomy takedown, lowanterior resection)), and delayed absorption of orally administeredmedications or nutritive substances.

Provided forms of a provided compound or composition are also useful intreatment of conditions including cancers involving angiogenesis, immunesuppression, sickle cell anemia, vascular wounds, and retinopathy,treatment of inflammation associated disorders (e.g., irritable bowelsyndrome), immune suppression, chronic inflammation.

In still further embodiments, veterinary applications (e.g. treatment ofdomestic animals, e.g. horse, dogs, cats, etc.) of use of a providedcompound or composition are provided. Thus, use of provided formulationsin veterinary applications analogous to those discussed above for humansubjects is contemplated. For example, inhibition of equinegastrointestinal motility, such as colic and constipation, may be fatalto a horse. Resulting pain suffered by the horse with colic can resultin a death-inducing shock, while a long-term case of constipation mayalso cause a horse's death. Treatment of equines with peripheral opioidreceptor antagonists has been described, e.g., in U.S. PatentPublication No. 20050124657 published Jan. 20, 2005.

It will also be appreciated that a provided compound or composition canbe employed in combination therapies, that is, a provided compound orcomposition can be administered concurrently with, prior to, orsubsequent to, one or more other desired therapeutics or medicalprocedures. Particular combination therapies (therapeutics orprocedures) to employ in a combination regimen will take into accountcompatibility of the desired therapeutics and/or procedures and thedesired therapeutic effect to be achieved. It will also be appreciatedthat therapies employed may achieve a desired effect for the samedisorder (for example, a formulation may be administered concurrentlywith another compound used to treat the same disorder), or they mayachieve different effects (e.g., control of any adverse effects). Asused herein, additional therapeutic compounds which are normallyadministered to treat or prevent a particular disease, or condition, areknown as “appropriate for the disease, or condition, being treated”.

In other embodiments, a provided compound or composition and unit doseforms are useful in preparation of medicaments, including, but notlimited to medicaments useful in the treatment of side effects of opioiduse (e.g., gastrointestinal side effects (e.g., inhibition of intestinalmotility, GI sphincter constriction, constipation) nausea, emesis,vomiting, dysphoria, pruritus, etc.) or a combination thereof. Compoundsof the present invention, and pharmaceutically acceptable compositionsand formulations thereof, are useful for preparations of medicaments,useful in treatment of patients receiving acute opioid therapy (e.g.,patients suffering from post-operative gastrointestinal dysfunctionreceiving acute opioid administration) or subjects using opioidschronically (e.g., terminally ill patients receiving opioid therapy suchas an AIDS patient, a cancer patient, a cardiovascular patient; subjectsreceiving chronic opoid therapy the pain management; or subjectsreceiving opioid therapy for maintenance of opioid withdrawal). Stillfurther, preparation of medicaments useful in the treatment of pain,treatment of inflammatory conditions such as inflammatory bowelsyndrome, treatment of infectious diseases, treatment of diseases of themusculoskeletal system such as osteoporosis, arthritis, osteitis,periostitis, myopathies, treatment of autoimmune diseases and immunesuppression, therapy of post-operative gastrointestinal dysfunctionfollowing abdominal surgery (e.g., colectomy (e.g., right hemicolectomy,left hemicolectomy, transverse hemicolectomy, colectomy takedown, lowanterior resection), idiopathic constipation, and ileus (e.g.,post-operative ileus, post-partum ileus), and treatment of disorderssuch as cancers involving angiogenesis, chronic inflammation and/orchronic pain, sickle cell anemia, vascular wounds, and retinopathy.

Still further encompassed by the invention are pharmaceutical packsand/or kits comprising a provided compound or composition and acontainer (e.g., a foil or plastic package, or other suitablecontainer). Optionally instructions for use are additionally provided insuch kits.

As described herein, the present invention provides methods fordetermining the purity of a sample of (R)—N-methylnaltrexone bromide. Tocertain embodiments, such methods can utilize reference standards. Theterm “reference standard” as used herein refers to “highly characterizedspecimens of drug substances, excipients, impurities, degradationproducts, dietary supplements, compendial reagents and performancecalibrators. They are required for use in conducting official USP-NFtests and assays.” as defined by the United States Pharmacopeia. Aswould be appreciated by one of ordinary skill in the art, USP ReferenceStandards are also used as calibrators (e.g., particle count, meltingpoint, and standardization of titrants and as blanks and controls).Reference Standards are used mainly in chromatographic andspectrophotometric procedures. In certain embodiments, the presentinvention provides compound II-1 as a reference standard. In someembodiments, the present invention provides a kit comprising a compoundII-1 reference standard and optionally one or more reference standardsof (R)—N-methylnaltrexone bromide, Impurity B, Impurity C, Impurity D,Impurity E, Impurity F, Impurity G, Impurity H, and Impurity I, asdescribed in detail in Example 1, below.

In order that the invention described herein may be more fullyunderstood, the following examples are set forth. It should beunderstood that these examples are for illustrative purposes only andare not to be construed as limiting this invention in any manner.

All features of each of the aspects of the invention apply to all otheraspects mutatis mutandis.

EXEMPLIFICATION General Procedures

Compound III-1 can be prepared, for example, according to the methodsdescribed in detail in International Patent Application publicationnumber WO2006/127899, the entirety of which is hereby incorporatedherein by reference.

Mass Spectral Analysis was performed using an Agilent 1100 HPLC systemcoupled with Applied Biosystems-PE SCIEX QSTAR PULSAR i quadrupoletime-of-flight tandem mass spectrometer equipped with an electrosprayionization ion source operated in the positive ionization mode. The HPLCeluent was split to allow a flow at approximately 50 μL/min into the ionsource of the mass spectrometer.

NMR spectroscopic analysis of compound II-1 was performed in DMSO-d₆ andthe spectra were acquired on a Bruker DRX-500 NMR spectrometer equippedwith a triple resonance inverse detection (TXI) probe TMS was used as aninternal reference for the proton resonances (δ¹H at 0.00) and thesolvent, DMSO-d₆, used as an internal standard for the carbon resonances(δ¹³C at 39.5).

The following abbreviations are used herein and have the followingmeanings:

Key to Abbreviations

Abbreviation Full Description δ = Chemical Shift 2D = Two Dimensionalamu = Atomic Mass Units COSY = Correlation Spectroscopy DMSO-d₆ =Dimethylsulfoxide-d₆ Da = Daltons dd = Doublet of doublets ESI-MS =Electrospray Ionization Mass Spectrometry HMBC = Heteronuclear MultipleBond Correlation HPLC = High Performance Liquid Chromatography HSQC =Heteronuclear Single Quantum Coherence M = Mass m/z = mass to charge mDa= milliDaltons min = Minutes MNTX = Methylnaltrexone bromide MS = MassSpectrometry MS/MS = Mass Spectrometry/Mass Spectrometry MV = Millivoltsnm = Nanometers NMR = Nuclear Magnetic Resonance ppm = parts per millionROESY = Rotating Frame Overhauser Effect Spectroscopy td = Triplet ofdoublets TFA = Trifluoroacetic acid TMS = Tetramethylsilane TRIS =Trishydroxymethylaminomethane UV = Ultraviolet UV-VIS = Ultraviolet -Visible

Example 1 Isolation and Characterization of RRT 0.60

Previously, at least three degradation products of methylnaltrexone(compound III-1) were identified from. HPLC analysis in 20 mg/mL,isotonic saline solution (identified as RRT peaks at about 0.72, 0.89,and 1.48 when products were analyzed by HPLC). See, e.g., U.S. PatentApplication Publication No. 20040266806, published Dec. 30, 2004, andWO2008/019115, published Feb. 14, 2008. Recently,methylnaltrexone-containing pre-filled syringes were examined forproduction of degradants. A new degradation product was observed, havinga RRT at about 0.60. FIG. 1 depicts the LC/MS result of a stabilitystudy of such a pre-filled syringe at 40° C. and 75% relative humidityafter 6 months.

For HPLC analysis a Prodigy ODS-315 cm×2.0 mm, 3 μm particles(Phenomenex) HPLC column at a flow rate of 0.25 mL/min, using thefollowing eluent:

-   -   Mobile Phase Strength (Isocratic: 75:25 (v/v) 0.1% TFA in        Water/Methanol Purity: (Gradient):    -   Mobile Phase A=95:5 (v/v) 0.1% TFA in Water/Methanol    -   Mobile Phase B=35:65 (v/v) 0.1% TFA in Water/Methanol    -   Gradient Program:

Time (Min) % Mobile Phase A 0 100 45 50 45.1 100 60 100

-   -   Column Temperature: 50° C.    -   Flow: 0.25 mL/minute    -   Detection: UV, 280 nm or 310 nm    -   Injection volume: 20 μL    -   Sample Solvent: 0.05M Dibasic Sodium Phosphate pH 6.8

The following standards of compounds and known impurities wereidentified with associated calculated relative retention times (“RRT”)and relative response factors (“RRF”):

Compound RRT RRF Impurity A: Diol degradant (II-1) 0.60 0.0068 ImpurityB: Ring contracted 0.79 1.00 Impurity C: Quinone degradant 0.89 0.0126Impurity D: S-Methylnaltrexone bromide 0.91 1.09 Methylnaltrexonebromide 1.00 1.00 Impurity E: Naltrexone base 1.16 0.79 Impurity F:2,2,bis-methylnaltrexone bromide 1.45 0.54 Impurity G:O-Methylnaltrexone methobromide 1.55 1.08 Impurity H: Aldol dimer 1.640.86 Impurity I: Hoffmann elimination 2.26 0.16

Impurity B, the RRT 0.79 degradant referred to as “Ring contracted,” wasidentified as a ring contracted form of (R)—N-methylnaltrexone bromideand has the following structure:

Impurity C, also referred to herein as compound IV-1, the RRT 0.89degradant referred to as “Quinone degradant,” was identified as a lightdegradation product of (R)—N-methylnaltrexone bromide, and has thefollowing structure:

In certain embodiments, the present invention provides a compositioncomprising one or more of Impurity A, Impurity B, Impurity C, ImpurityD, Impurity E, Impurity F, Impurity G, Impurity H, and Impurity I. Insome embodiments, the present invention provides a kit comprising a vialcomprising each of (R)—N-methylnaltrexone bromide, Impurity A, ImpurityB, Impurity C, Impurity D, Impurity E, Impurity F, Impurity G, ImpurityH, and Impurity I. In certain aspects, the present invention provides akit comprising each of (R)—N-methylnaltrexone bromide, Impurity A,Impurity B, Impurity C, impurity D, Impurity E, Impurity F, Impurity G,Impurity H, and Impurity I, wherein each impurity compound is containedwithin a separate vial.

Impurity A, the RRT 0.60 compound, referred to above as “Dioldegradant,” was isolated and characterized and corresponds to compoundII-1. Specifically, LC/MS was conducted on the unknown peak eluting atRRT 0.60 in the (R)—N-methylnaltrexone pre-filed syringe stabilitysample. FIG. 2 depicts the total ion chromatogram (TIC), UV chromatogram(λ=280 nm), mass and UV spectra obtained for the RRT 0.60 peak. The UVspectrum has a unique absorption around 310 nm, which is similar to thepreviously identified quinone compound which as a RRT of about 0.89.

The measured accurate mass of 372.1.809 amu corresponds to the elementalcomposition of C21H26NO5+ (error: 0.4 mDa). Its molecular formulaindicates that the unknown peak contains one more oxygen atom than theabove-depicted quinone compound.

Example 2 Synthetic Preparation of compounds II-1 and II-3

Method A

A solution of compound III-1 was dissolved in 1M TRIS pH 8 buffer andH₂O₂ (30%) was added in a 1:1.2 molar ratio. Before HPLC injection, thereaction was stopped by addition of TFA and the solution changed frombrown/red to yellow. The solution was injected into a preparative HPLCwith a Sunfire column (50×250 mm, C18, 5 μm), flow rate of 100 mL/min,and a mobile phase that started at 6% MeOH/0.25% TFA for 1 min and thenwas changed to a gradient of 12% MeOH/0.25% TFA in 30 min. The collectedfraction was diluted with two parts of water and the compound wasadsorbed onto a reverse phase polymeric sorbent (Strata-X fromPhenomenex). The column was placed under vacuum to remove all remainingliquid and acetonitrile was used to elute the compound.

About 20% water was added to the eluent which was then passed through astrong anion exchange column charged with bromide (Strata-SAX fromPhenomenex). Acetonitrile was removed from the eluent by extraction withdichloromethane. The pH of the aqueous layer was adjusted to 4.2 (theoptimum acidity to avoid hydrolysis), and then lyophilized to get a redpowder. The compound was crystallized by dissolving the red powder inwater and putting the solution in a water bath ah at 70° C., whichcaused crystals to firm immediately. The crystals were filtered anddried under vacuum to provide compound II-1 as red crystals. The X-raydiffraction pattern for the resulting crystalline compound II-1 isdepicted in FIG. 12. The mass spectrogram of the resulting crystallinecompound II-1 is depicted in FIG. 13. The ¹H NMR of the resultingcrystalline compound II-1 is depicted in FIG. 14.

Method B

A solution of compound III-1 was dissolved in 1M TRIS pH 8 buffer andH₂O₂ (30%) was added in a 1:2 molar ratio. After about 30 minutes atroom temperature, the reaction was stopped by addition of TFA and thesolution changed from brown/red to yellow. The solution was injectedinto a preparative HPLC with a Sunfire column (50×250 mm, C18, 5 μm),flow rate of 100 mL/min, and a mobile phase that started at 6%MeOH/0.25% TFA for 1 min and then was changed to a gradient of 12%MeOH/0.25% TFA in 30 min. The collected fraction was immediately frozenand lyophilized to afford compound II-3 as a yellow solid.

The reaction of compound III-1 with H₂O₂ to form compound. II-3 wasperformed under different pH conditions to determine the effect of pHupon the reaction. It was found that at acidic pH the reaction ofcompound III-1 with H₂O₂ is very slow, whereas at basic pH the reactionis faster, following increase of pH (see FIG. 3).

Structural elucidation of compound II-3 was determined using: UVspectroscopy; ESI-MS; MS/MS; ¹H NMR. ¹³C NMR, and 2 dimensional NMRtechniques, as described in detail below. Positional numbering is asdepicted below.

NMR Results

The ¹H and ¹³C NMR resonances were assigned using COSY, HSQC, HMBC andROESY spectra. The assignments are set forth in Table 1, below.

TABLE 1 ¹H and ¹³C Resonance Assignments for Compound II-1 in DMSO-d₆

Position Group Carbon shift^(a) Proton shift^(b)  1 CH 141.0 7.33(doublet, J = 9.6 Hz)  2 CH 127.1 6.38 (doublet, J = 9.6 Hz)  3 C 182.2—  4 C 151.1 —  4-OH OH — 12.21  5 CH  74.8  5.08  6 C 205.7 —  7 CH₂ 35.1 2.70, 2.16  8 CH₂  34.2  1.93  9 CH  66.7 4.44 (doublet, J = 7.0Hz) 10 CH 129.1 6.59 (doublet, J = 7.0 Hz) 11 C 139.3 — 12 C 113.5 — 13C  48.5 — 14 C  72.4 — 14-OH OH —  6.82 15 CH₂  24.8 2.50, 1.95 16 CH₂ 53.8 3.35 (dd, J = 13.8, 3.3 Hz), 3.01 (td, J = 13.8, 3.1 Hz) 17 CH₂ 70.7 3.51 (dd, J = 13.4, 5.0 Hz), 2.87 (dd, J = 13.4, 9.2 Hz) 18 CH 4.0  1.34 19 CH₂  5.4 0.77, 0.57 20 CH₂  3.2 0.72, 0.40 21 CH₃  49.7 3.59 ^(a)Shifts relative to DMSO-d6 (δ¹³ C = 39.5). ^(b)Shifts relativeto TMS (δ³ H = 0.0).

The COSY spectrum (FIG. 6) shows that all the ¹H-¹H spin systems are thesame as those observed for the quinone compound, Impurity D, except forH-5. In the quinone compound, Impurity D, C-5 is a methylene carbon withtwo well resolved diastereotopic protons and in compound II-1, H-5 is amethine proton at δ 508. The presence of the C-5 methine was confirmedby the HSQC spectrum (FIG. 7) which shows that H-5 is attached to acarbon at δ 74.8, a typical chemical shift for a carbon attached tooxygen.

In the ¹H NMR spectrum (FIG. 8) there are two hydroxyl protons observedat δ 12.21 and 8.58, assigned to the C-4 and C-5 OH groups,respectively. Their downfield chemical shifts and broad peak shape implythat they are very close each other, indicating that the C-5 hydroxyl isin the α orientation as depicted below.

The HMBC spectrum (FIG. 9) provides additional evidence that thehydroxyl group at C-5 is facing down. H-5 shows a strong three bondcorrelation to C-12, requiring their anti-coplanar relationship asdepicted below:

The axial orientation of H-5 is confirmed by the ROESY spectrum (FIG.10). H-5 shows 1,3-diaxal type of NOEs to C-14-OH at δ 6.82, H-8 at δ2.70, and H-14 at δ 2.50. The ¹³C NMR spectrum of compound II-3 is shownin FIG. 11.

Example 3 Comparison of Synthetic Compound II-3 and Isolated RRT 0.60

Compound II-3, prepared according to Example 2, Method B, was analyzedby LC-MS. As depicted in FIG. 2, the major peak elating around 9 minuteshas the same mass and UV spectra as the RRT 0.60 peak. Also, themeasured accurate mass of 372.1785 amu provides the same ionic formula(error: —2.0 mDa). In addition, compound I-3, prepared according toExample 2, Method B, was spiked into the sample obtained from thestability study described at Example 1. FIG. 4 shows the UVchromatograms of both the non-spiked and spiked samples. The peak at RRT0.60 clearly indicates that the synthetic compound II-3 is the samecompound. LC-MS/MS was conducted on the ion of m/z 372 to get structuralinformation. MS/MS data for the RRT 0.60 peak and the synthetic sampleare shown in the bottom two boxes in FIG. 4. Both spectra are quitesimilar although the synthetic compound provides much better fragmention intensities. Fragmentation assignments with the chemical structurebased on NMR data are shown in FIG. 5. The LC/MS data are consistentwith the structure as determined by NMR experiments.

Example 4 Evaluation of Oxidation Method

As described above in Example 2, compound II-1 was prepared by oxidationof compound III-1 with H₂O₂. A screen of additional oxidizing reagentswas performed to optimize yield and purity of the oxidation reaction. Asummary of the reactions performed is set forth in Tables A though E,below. As used herein, the term “SLI” refers to the single largestimpurities.

As summarized in Table A, below, reactions were performed at roomtemperature using 1 equivalent of different oxidizing agents.

For each reaction, 0.5 g of III-1 was combined with 6 mL of TRIS.HCl(1M, pH 8.0) in water. Oxidizing reagent (1 equivalent) was added andthe resulting mixture stirred at room temperature for the designatedtime. All reactions were monitored by HPLC at 280 nM. % values reportedas is from the chromatogram

TABLE A HPLC % % Time % % % other Oxidant/Rx Conditions (h) II-1 III-1SLI imps 1 30% H₂O₂ 0.13 mL 2.5 28 64.5 3.0 4.5 4.5 32 60 4.0 4.0 2043.6 34.2 8.0 14.2 2 70% tBuOOH 0.16 mL 2.5 4.7 93 0.7 1.6 4.5 7.1 901.2 1.7 20 20 70.9 3.3 5.8 3 Oxone + Acetone + NaHCO₃ 2.5 14 29 16.041.0 0.7 g Acetone 0.36 mL 4.5 14 29 16.0 41.0 NaHCO₃ 0.33 g 20 12.8 2514.7 47.5 4 DDQ 0.26 g 2.5 0.3 11 28.0 61.7 4.5 0.3 11 25.0 63.7 20 0.310.9 21.8 67.0 5 32% Peracetic acid 0.24 mL 2.5 8.8 47 10.0 34.2 4.5 8.847 10.0 34.2 20 8.4 45.6 10.8 35.2 6 77% mCPBA 0.256 g 2.5 25.1 42.9 6.925.1 4.5 25 42 7.1 25.9 20 25 38.4 6.3 30.3

As summarized in Table B, below, oxidation reactions were performed withvarying equivalents of oxidizing reagent (i.e., oxidant) and varyingreaction times.

For each reaction, 0.5 g of III-1 was combined with 6 mL, of TRIS.HCl(1M, pH 8.0) in water and cooled to ˜10° C. Oxidizing reagent (in thespecified amount) was added and the resulting mixture stirred at roomtemperature for the designated time.

TABLE B HPLC % % Time % % % other Oxidant Equivs. (h) II-1 III-1 SLIimps 1 30% H₂O₂ 2 2 2 91 2.5 4.5 0.26 mL 4 2.3 87 4.4 6.3 20 3.4 84.64.9 7.1 2 30% H₂O₂ 5 2 0 93 2 5 0.65 mL 4 0 92 2.6 4.4 3 70% tBuOOH 2 27.2 90.1 1.4 1.3 0.32 mL 3 17.2 78 2.2 2.6 20 40.5 46.5 4.3 8.7 1 h at39.6 35.6 5.9 18.9 50 C. 44 43.1 29.1 5.3 22.5 72 43 22 8.3 26.7 90 44.319 10.3 26.4 4 70% tBuOOH 5 2 13.3 82 2.1 2.6 0.8 mL 4 28 66 2.3 3.7 2053.7 33.1 3.2 10 1 h at 49.6 25.4 9.4 15.6 50 C. 44 54 19.3 9.7 17 7255.1 12.3 6.8 25.8 90 53.4 10.7 6.9 29 5 77% mCPBA 2 2 24.5 38.5 9.927.1 0.512 g 20 20.2 30.4 12.7 36.7 6 77% mCPBA 5 2 18.6 31.6 15.3 34.51.28 g 20 13.8 25.7 11 49.5

As summarized in Table C, below, oxidation reactions were performed withH₂O₂ and tBHP in varying equivalents and prolonged stirring at roomtemperature.

For each reaction, 0.5 g of II-1 was combined with 6 mL of TRIS.HCl (1M,pH 8.0) in water. The oxidant was added and the resulting mixturestirred for the designated time,

TABLE C HPLC % % Time % % % Other Oxidant Equivs. (h) II-1 III-1 SLIimps 1 30% H₂O₂ 1 2 22.3 72 2 3.7 (0.13 mL) 18 35.4 43.8 7.1 13.7 2840.4 32.8 8.2 17.6 44 44.5 21.7 8.8 25 2 30% H₂O₂ 2 (0.26 mL) 20 5.989.1 1.1 3.9 3 30% H₂O₂ 5 (0.65 mL) 20 2.1 94.3 2 1.6 4 70% TBHP 5 (0.8mL)  2 15 82.8 0.9 1.3 18 54.2 37.2 2.3 6.3 28 60 28.5 2.4 9.1 44 63.220.2 3.2 13.4 92 62 11.4 6.9 19.7 5 70% TBHP 10 (1.6 mL)  2 19.5 77.11.4 2 18 60.4 30 2 7.6 28 64.3 22.2 3.2 10.3 44 65.4 15.6 6.6 12.4 92 628.9 11.5 17.6

As summarized in Table D, below, oxidation reactions were performed withtBHP in varying equivalents and prolonged stirring at elevatedtemperature (35° C.).

For each reaction, 0.5 g of III-1 was combined with 6 mL of TRIS HCl(1M, pH 8.0) in water. Oxidant was added in the designated amount andthe reaction stirred for the designated time at 35° C.

TABLE D HPLC % % Time % % % other Oxidant Equivs. (h) II-1 III-1 SLIimps 1 70% TBHP 2 2 21.7 73.1 1.3 3.9 18 45.3 34 3.7 17 2 70% TBHP 5 233.8 61.6 1.5 3.1 18 56 22.5 5.2 16.3 3 70% TBHP 10 2 40 53 2.4 4.6 1854.1 17.5 14.3 14.1

As summarized in Table E, below, oxidation reactions were performed withtBHP in varying solvents.

For each reaction, 0.5 g of III-1 was combined with 3 mL of TRIS.HClbuffer (1M, pH 8.0) and designated solvent (3 mL). 70% TBHP (5 equivs)was added and the resulting mixture stirred at room temperature for 48hours.

TABLE E HPLC % 280 nM Oxidant Solvent % II-1 % III-1 % SLI % other imps1 TBHP, 2eq. None 52 36 3.5 8.5 2 TBHP None 63 22.6 3.3 11.1 3 TBHP EtOH26 61 6.6 6.4 4 TBHP NMP 15 77 3.9 4.1 5 TBHP DME 23 60 10 7 6 TBHP THF31 47 13 9

Example 5 Tungstate Stability Studies

A short-term evaluation was conducted to investigate the effect oftungstate on methylnaltrexone bromide for the formation of RRT 0.60under the stressed conditions of high temperature and oxygen exposure.For the stressed sample, the formulation was spiked with 1 mM sodiumtungstate and sparged with oxygen for one hour at room temperature. Thesolution was then autoclaved at 121° C. for one hour. Control sampleswere also prepared where each solution was prepared without exposure totungstate, oxygen or heat.

After the stressed conditions discussed above, the sample exposed totungsten, oxygen and heat produced 28 ppm of RRT 0.60 degradant. Thisdegradant was observed at lower levels in the control samples. Based onthis study, tungsten may aid in catalyzing the formation of the RRT 0.60degradant. The levels of RRT 0.60 degradant observed in the controlsamples show that temperature and oxygen content are also contributingfactors in this oxidative degradation reaction.

Tungstate Evaluation - Short-term Stressed Study 1 mM Tungstate OxygenAutoclave RRT 0.60 (ppm) Sample 1 ≦7 ppm Sample 2 X ≦7 ppm Sample 3 X 9Sample 4 X X ≦7 ppm Sample 5 X X 17 Sample 6 X X X 28

A long-term evaluation of 18 months was conducted to investigate theeffect of tungstate on methylnaltrexone bromide for the formation of RRT0.60 under standard conditions in standard Sterile, Clean, Ready to Fill(SCF™) syringes (1 mL. Becton Dickinson (BD) Syringe, Type 1borosilicate glass with stainless steel needle 27×½ inch, BD Stopper11510, West 4023/50 grey bromobutyl rubber. Coating: contact side withDalkyo Fluoro Tee, remaining part with B2-40 coating, BD Rigid NeedleShield with FM27/0 rubber needle shield and polypropylene rigid shieldcover). In this study, syringes containing either an 8 mgmethylnaltrexone unit dosage (8 mg methylnaltrexone in 0.4 mL water with2.6 mg sodium chloride, 0.16 mg edetate calcium disodium, and 0.12 mgglycine hydrochloride) or a 12 mg methylnarexone unit dosage (12 mgmethylnaltrexone in 0.6 mL water 3.9 mg sodium chloride, 0.24 mg edetatecalcium disodium, and 0.18 mg glycine hydrochloride) were stored underthe following conditions: 25° C./60% RH, 30° C./75% RH, and 40° C./75%RH. The results of this study show that the RRT 0.60 compounds formed toa level of 40 ppm at 25° C. and 60% RH and up to 204 ppm at 30° C. and75% RH. After 6 months at 40° C. and 75% RH, 145 ppm was observed. Theseresults are shown in Table 2, below.

TABLE 2 Amount of RRT 0.60 (ppm) in Standard SCF Syringes* Time Batch#Zero 1 month 3 months 6 months 9 months 12 months 18 months Condition:25° C./60% RH G16 8 mg <7 8 13 13 17 18 26 G17 8 mg <7 <7 16 13 18 19 27G18 8 mg <7 <7 10 12 15 18 40 G19 12 mg <7 <7 15 14 18 14 36 G20 12 mg<7 <7 14 8 18 19 24 G21 12 mg <7 <7 11 16 16 14 31 Condition: 30° C./75%RH G16 8 mg NA 8 15 16 28 26 101 G17 8 mg NA 9 12 20 23 22 70 G18 8 mgNA <7 12 11 28 34 90 G19 12 mg NA 10 14 12 21 23 55 G20 12 mg NA <7 1830 22 29 86 G21 12 mg NA <7 16 21 28 90 204 Condition: 40° C./75% RH G168 mg NA 10 33 100 NA NA NA G17 8 mg NA 21 57 47 NA NA NA G18 8 mg NA 1422 145 NA NA NA G19 12 mg NA 20 50 121 NA NA NA G20 12 mg NA 18 47 116NA NA NA G21 12 mg NA 11 69 102 NA NA NA Note: All values reported inppm, acquired by the 310 nm HPLC method. LOQ = 7 ppm NA = not applicable

Another stability study was conducted to investigate the effect ofstoring methylnaltrexone bromide in an “ultra low” tungsten syringe(Becton Dickenson) for the formation of RRT 0.60 (1 mL BD Syringe, Type1 borosilicate glass with stainless steel needle 29G×½ inch, (ultra lowtungsten), BD Stopper 11510, West 4023/50 grey bromobutyl rubber,Coating: contact side with Dalkyo Fluoro Tee, remaining part with B2-40coating. BD Rigid Needle Shield, with thermoplastic elastomer (TPE)needle shield and polypropylene rigid shield cover). The results of thisstudy show that no RRT 0.60 compound formed at a level of 25 ppm orgreater after 6 months at 40° C. and 75% relative humidity or 9 monthsat 25° C. and 60% relative humidity. These results are shown in Table 3,below.

TABLE 3 Amount of RRT 0.60 (ppm) in Ultra Low Tungsten Syringes*Conditions MNTX T₀ 1 mo 3 mo 6 mo 9 mo 12 mo 25° C./60% RH 8 mg <7 <7 <7<7 7 14 30° C./75% RH 8 mg <7 <7 9 <7 11 20 40° C./75% RH 8 mg <7 <7 1414 NA NA *All values reported in ppm, acquired by the 310 nm HPLCmethod. LOQ = 7 ppm NA = not applicable

Example 6 X-Ray Diffraction Study of Compound II-1 Polymorph

The powder XRD analysis of compound II-1 polymorph, prepared accordingto Example 2, Method A, was performed on a X'PERT-MPD Powder X-rayDiffractomneter.

The samples were ground to a fine powder and packed into a cavity stylesample holder with a zero background plate. The peak positionscharacterized by powder X-ray diffraction of angle position (2θ) are asdepicted in FIG. 15. In certain embodiments, the present inventionprovides a crystalline form of compound II-1 characterized in that saidform has a powder X-ray diffraction pattern substantially similar tothat depicted in FIG. 15.

Example 7 HPLC Method

As described herein, detection and quantification of potentialimpurities of methylnaltrexone bromide is an important, and regulated,aspect of drug quality and purity. Another aspect of the inventionprovides an analytical method useful for detecting Impurity A, alsoreferred to herein as the RRT 0.60 degradant, impurity, or compound andalso as compound II-1, at levels required by regulatory standards. Incertain embodiments, the analytical method is capable of detectingImpurity A at a level of about 2.5 ppm in a sample of N-methylnaltrexonebromide. In some embodiments, the analytical method is capable ofdetecting impurity A at a level of less than about 25, about 100, about125, about 150, about 185, about 187, or about 190 ppm in a sample ofN-methylnaltrexone bromide. In certain embodiments, such an analyticalmethod is as follows:

-   -   Column: Prodigy ODS (3) 15 cm×4.6 mm, 3 μm particles;    -   Flow rate: 1.0 mL/min;    -   Detection: 310 nm. UV;    -   Column Temperature: 37° C.;    -   Autosampler Temperature: 5° C.;    -   Sample Solvent: pH 5.0 Sodium Acetate buffer with EDTA (prepared        from dissolving about 238 g NaOAc in 3 L of water. Add 45 mL        glacial acetic acid and dilute to 50 L with water);    -   Mobile Phase A=950 mL/50 mL/1 mL Water/Methanol/TFA;    -   Mobile Phase B=500 mL/500 mL/1 mL Water/Methanol/TFA;    -   Gradient Program:

Time (Min) % Mobile Phase A % Mobile Phase B 0 93 7 20 73 27 20.1 0 10025 0 100 25.1 93 7

Preparation of a standard sample of N-methylnaltrexone bromide, at aconcentration of 0.0004 mg/mL, is performed as follows: 20 mg ofN-methylnaltrexone bromide is weighed into two separate 100.0 mLvolumetric flasks. 50 mL of sample solvent is added to dissolve theN-methylnaltrexone bromide and the resulting solution is diluted tovolume with sample solvent. 2.0 mL of the resulting solution arepipetted into the second 100 nm volumetric flask which is then dilutedto volume with sample solvent.

The amount of compound II-1 present in a sample of(R)—N-methylnaltrexone bromide is calculated using the followingequation:

${{Compound}\mspace{14mu}{II}\text{-}1\mspace{14mu}({ppm})} = \frac{({Ai})({Cr})(V)({RF})(1000000)}{({Ar})({Ws})}$

-   -   where:    -   Ai=Area of impurity peak from the sample chromatogram;    -   Cr=Concentration of (R)-2 methylnaltrexone bromide in the        standard preparation (mg/mL);    -   V=Volume of the sample solution (mL);    -   RF=Response Factor correction for compound II-1;    -   1000000=Conversion factor (ppm);    -   Ar=Average area of (R)—N-methylnaltrexone bromide from the        standard chromatogram;    -   Ws=Sample weight of (R)—N-methylnaltrexone bromide (mg).

Example 8

Levels of tungsten, or derivatives thereof, may be measured by anytechnique including the method described in US 20080103438. Levels oftungsten, or derivatives thereof, in empty syringes can be determined byextraction followed by ICP-MS analysis. Such extraction and analyticalmethods are known to one of ordinary skill in the art and include thosedescribed in EPA Methods 6020A and 200.8, the entirety of which ishereby incorporated herein by reference.

Different techniques may provide different results depending on howaggressively the tungsten or derivatives thereof is removed from theglass medical container for testing (i.e., more aggressive techniques,such as with acids, remove higher levels of tungsten residue). Forexample, a glass medical container can be washed, i.e., extracted, withan acid-containing solution and the extract measured for tungsten suchas described in Wang, et al., Journal of Pharmaceutical and BiomedicalAnalysis, 19 (1999) 937-943, “Determination of Tungsten in Bulk DrugSubstance and Intermediates by ICP-AES and ICP-MS”, which isincorporated herein by reference in its entirety. Similar methodologycan be used for measuring tungsten-containing residue levels.

The following method is a general method that may be used to determinethe amount of tungsten present in an empty syringe:

-   -   1. filling a glass medical container (e.g., empty syringe) with        purified water (e.g., prepared by laboratory purification        system, Millipore Milli Ro 4) and sealing the glass medical        container (e.g., with a tip cap);    -   2. placing the filled glass medical container into an ultrasonic        bath containing water at ambient temperature for 60 minutes;    -   3. removing the glass medical container and dispensing the        contained solution into a sample vessel; and    -   4. measuring the concentration of the tungsten in the solution        by Inductively Coupled Plasma Mass Spectrometry (ICP/MS).

Example 9

According to the general scheme above, a solution of compound III-1 wasdissolved in M TRIS pH 8 buffer and t-butyl hydroperoxide (5 molarequivalents) was added and the resulting mixture stirred at roomtemperature for two days. The reaction was stopped by addition of TFAand the solution was extracted with dichromomethane. The aqueous phasewas separated and concentrated for HPLC injections. Preparative HPLCpurification was performed on a Sunfire column (50×250 nm, C18, 5 μmfrom Waters) at flow rate of 50 mL/min with a mobile phase that startedat 5% ACN/0.1% TFA and was changed to a gradient of 10% ACN/0.1% TFAover 30 min. The collected fractions were lyophilized and subjected to asecond pass purification at the same condition as the first pass. Thepooled fraction were applied on a reverse phase SPE (solid phaseextraction) tube (Strata-X from Phenomenex) which was placed undervacuum to remove all remaining liquid. Then 20% acetonitrile/water wasused to elute the compound, which was then passed through a strong anionexchange SPE tube (Strata-SAX from Phenomenex) pretreated with sodiumbromide. The collected solution was lyophilized to afford compound II-1as a red powder.

More specifically, 100 g N-(cyclopropylmethyl)-noroxymorphonemethobromide (III-1) was charged into a magnetically stirred 2 l flaskwith thermocouple followed by the addition of 600 mltris(hydroxymethyl)aminoethane. The slurry was then charged with 180 ml70% t-butyl hydroperoxide (5 equivalents), at which time the slurrybecomes solution and gradually darkens in color. The solution wasstirred for 69 hours at ambient temperature and was measured at 62-67%conversion by HPLC. The solution was then charged with 20 mltrifluoroacetic acid to pH 2 and was washed with 800 ml methylenechloride. The layers were separated and again the aqueous was washedwith 200 ml methylene chloride. The waste organic fractions werecombined and back extracted with 2×200 ml water. All aqueous fractionswere then combined to wash with 2×400 ml of fresh methylene chloride.The layers were then separated and the aqueous portion (˜1.1 L)containing compound II-3 was isolated (yield unknown) and stored at −20C to await the purification step. The analytical method utilized toassess % conversion was as follows:

-   -   Analytical Method for Crude Aqueous Product    -   Agilent 1100 HPLC    -   column: 4.6 mm×150 mm Sunfire C18    -   λ280 nm    -   flow rate: 1 ml/min    -   Gradient:

Time % A water w/0.1% TFA % B acetonitrile w/0.1% TFA 0 95 5 10 85 15 125 95 15 5 95 16 95 5 20 95 5

The crude compound II-3 was purified by preparatory HPLC using thefollowing method.

-   -   Varian PrepStar pumps with Varian Prostar 320 Detector    -   column: 50 mm×250 mm Sunfire C18 5 micron    -   λ260 nm    -   flow rate: 50 ml/min    -   Gradient

Time % A water w/0.1% TFA % B acetonitrile w/0.1% TFA 0 95  5 (flow rate= 0) 1 95  5 (flow rate = 50 ml/min) 31 90 10 35 10 90 40 10 90 42 95  547 95  5 48 95  5 (flow rate = 0)

The first pass preparatory HPLC purification was done by injecting 100ml per injection and collecting 50 ml fractions with the use of anautomated fraction collector. Typically, fractions 15-22 were collected,combined and lyophilized.

The second pass preparatory HPLC purification was done by loading thecollected crude TFA salt material (crude II-3), about 2 g each, dilutedwith 20 ml water, back to the prep column with same gradient and buffersystem. Fractions 23-29 were typically collected and combined. Thiscombined fraction was then diluted 1:1 with water, split into 4 equalvolumes and then applied onto 4 Strata-X SPE Giga Tube (60 nm, reversephase resin trap) which have been prepared with following procedure:

-   -   Flush procedure for reverse phase column (Strata X 33 micron);    -   Elute 3 bed volumes of acetonitrile followed by 3 bed volumes of        water; and    -   The tube was vacuum dried for 5 min before the desired fraction        was eluted by 20% ACN-water and collected (˜20 ml×4).

The combined solution was split into 4 equal volume and applied onto 4Strata SAX SPE Giga Tube (60 ml, strong anion exchange resin) which wereprepared with the following procedure:

-   -   Flush procedure for ion exchange column Strata SAX 55 micron;        and    -   Elate 3 bed volumes of acetonitrile followed by 3 bed volumes of        1M sodium bromide followed by 5 bed volumes of water.

The desired fraction was collected and the tube was washed by 20%ACN-water until no colored solution was eluted. A total of ˜45 ml×4 wascollected, pooled and lyophilized.

The multi-lots of lyophilized material were re-dissolved in water (˜16 gin 150 ml of water) and lyophilized to afford 15.9 g of II-1 as a darkred fluffy solid.

While we have described a number of embodiments of this invention, it isapparent that our basic examples may be altered to provide otherembodiments that utilize the compounds and methods of this invention.Therefore, it will be appreciated that the scope of this invention is tobe defined by the appended claims rather than by the specificembodiments that have been represented by way of example.

What is claimed is:
 1. A method of treating a gastrointestinal disorderin a subject, comprising administering to the subject a compound offormula III

contained within a packaged composition substantially free of tungsten,wherein A⁻ is a suitable anion; wherein the packaged compositioncomprises less than about 190 ppm of a compound of formula II

wherein X⁻ is a suitable anion.
 2. The method of claim 1, wherein thegastrointestinal disorder is constipation.
 3. The method of claim 2,wherein the constipation is opioid-induced.
 4. The method of claim 1,wherein the compound of formula III is provided in a solution.
 5. Themethod of claim 1, wherein the compound of formula III is of formulaIII-1


6. The method of claim 5, wherein the compound of formula III isprovided in solution.
 7. The method of claim 5, wherein thegastrointestinal disorder is constipation.
 8. The method of claim 7,wherein the constipation is opioid-induced.
 9. The method of claim 1,wherein the subject is receiving opioids chronically.
 10. The method ofclaim 9, wherein the subject is a cancer patient.
 11. The method ofclaim 1, wherein the packaged composition is selected from the groupconsisting of a syringe, a vial, a sachet and an ampoule.
 12. The methodof claim 1, wherein the packaged composition is a syringe.
 13. Themethod of claim 1, wherein the compound of formula III is in the form ofa tablet, a capsule, a powder, a solution, a suspension, an emulsion, agranule, and a suppository.
 14. The method of claim 1, wherein thesolution comprises less than about 190 ppm total of the compound offormula II and a compound of formula IV:

wherein R1 and R2 are each independently C1-6 aliphatic; and X is asuitable anion.
 15. The method of claim 6, wherein the compound offormula III is administered by injection or infusion.
 16. The method ofclaim 15, wherein the compound of formula III is administered bysubcutaneous injection.
 17. The method of claim 1, wherein the subjectis receiving an opioid at a morphine equivalent dose of between about 30and about 100 oral mg/day of methadone.
 18. The method of claim 1,wherein the tungsten is present in an amount of less than 50 parts perbillion.
 19. The method of claim 1, wherein the tungsten is present inan amount of less than 12 parts per billion.
 20. The method of claim 6,wherein the solution further comprises edetate calcium disodium andglycine hydrochloride.
 21. The method of claim 6, wherein the solutioncomprises about 8 mg of the compound of formula III in about 0.4 mLwater.
 22. The method of claim 21, wherein the compound of formula IIIis of formula III-1


23. The method of claim 6, wherein the solution comprises about 12 mg ofthe compound of formula III in about 0.6 mL water.
 24. The method ofclaim 23, wherein the compound of formula III is of formula III-1


25. The method of claim 1, wherein the compound of formula III is stableunder ambient storage conditions.
 26. The method of claim 25, whereinthe compound of formula III is stable for at least 24 months.
 27. Amethod of treating opioid induced constipation in a subject, comprisingadministering to the subject a compound of formula III-1

contained within a packaged composition substantially free of tungsten;wherein the packaged composition comprises less than about 190 ppm of acompound of formula II:

wherein X⁻ is a suitable anion.
 28. A method of treating constipation ina subject, comprising administering to the subject a unit dosage of acompound of formula III-1

wherein the compound of formula III-1 is administered with a syringethat is substantially free of tungsten; wherein the syringe comprisesless than about 190 ppm of a compound of formula II

wherein X⁻ is a suitable anion.
 29. A method of treating constipation ina subject, comprising administering to the subject a unit dosage of acompound of formula III

wherein the compound of formula III is administered with a syringe thatis substantially free of tungsten, wherein A⁻ is a suitable anion; andwherein the syringe comprises less than about 190 ppm of a compound offormula II:

wherein X⁻ is a suitable anion.